Interview questions to ask your homebirth midwife

I'm going to write this with the assumption that you have chosen to have a homebirth. I will assume that you have done your research, carefully weighed the pros and cons, and are comfortable with that decision. I am going to assume that you have decided to take responsibility for who you will hire, and for your part in the decision making that comes with having a homebirth and out of hospital care. I'm going to assume that you are a competent adult with no prior medical history that would rule you out of homebirth care with a midwife.

First let's start with a breakdown of important terms when it comes to midwives. There are different types of midwives, and if you scroll down you can see what those types are on this page from MANA. What they leave out of those definitions, and I think this is important, is that only the CNMs and CMs are required to have a masters degree in midwifery. The CNM is also licensed in all 50 states. The CM is only licensed in three. (I'll be honest, I've never quite understood the CM designation because it is only licensed in three states but if you live in one of those states I suppose it makes sense?) Also, only CNMs and CMs can prescribe medications legally. 
CPMs can often administer and carry meds, depending on the state and how licensing and regulations are in their state. CNMs and CMs are the only midwives that serve high risk women in the hospital setting.

CPMs and DEMs do not. CPMs receive all of their training with a more holistic model, geared specifically towards homebirth and possibly birth center practices in certain states. CPMs who are entry level have attended a minimum of 40 homebirths before becoming certified. They must also show proficiency in 43 pages worth of midwifery skills, take a second skills verification, and then sit for the NARM exam. CNMs often do not attend homebirths during their training but that varies. CNM schools also vary in the amount of births needed before the graduate can sit for her final certification exam. Some schools require 20 births, some 40, some are in between or more. All CNMs have extensive experience in labor and delivery as most schools require 2 years of labor and delivery experience before they will accept a student into their CNM program. All CNMs are certified by the AMCB

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Here in PA, we have an association called the midwives alliance of pennyslvania, or MAP. They have a section called know your local midwife, which is a starting point of questions to ask when interviewing a midwife. Some of what I say here may differ or repeat what they have on that site. If you are interested in promoting midwifery and safe homebirth options in PA, please get involved in the varying state midwifery organizations to make that possible. There is also Pennsylvania Families for safe birth. 

So here are some good questions to ask and why they are important. This is geared towards birth in PA, but could be utilized in other states.

How long have you been a midwife?

• You may not mind if you have a relatively new midwife, but this is good information to know. More experience may mean better, or it could mean stuck in their ways, it can be bad on both ends or good. A midwife with under a hundred births to her name is likely not as experienced in identifying and managing difficult situations. If your midwife has 30+ years of experience that can be amazing, and it can be a bit scary if she practices alone. Most homebirth midwives start practicing when they are around 30-35 so if she is advancing in age she could tire more easily and it is possible to have memory lapses or questionable judgement particularly at long births. If she practices with a partner or has another younger midwife with her this is less of a factor. I am not saying this is true across the whole of midwifery but this is simply the facts of life and aging.

Why did you become a midwife?

• Usually you will get the same types of answers for this one, but it speaks to the philosophy of birth that your particular midwife has.

Are you certified, and if not, why?

• In PA, no certification is required. Some women prefer that, some midwives have political differences with the certifying agencies, some don't want to be held accountable.

Are you licensed? If not, why?

• Unless she is a CNM, she can't be licensed in PA. If she has her CNM and is no longer licensed, it's a good question to ask why. The political climate towards all midwives can be tense or difficult to navigate for all types of midwives in PA. She may be licensed in a neighboring state.

How many births (approximately) have you attended?

• Again this goes to how much experience your midwife has overall.

Have you had any bad outcomes? If so, without revealing identifying factors, can you describe what happened?

• Every provider at some point if they practice long enough is going to have a bad outcome. If they deny this happening, I would strongly suspect that they are lying unless they are fresh out of school/training. A bad outcome may or may not be their fault and sometimes a baby has a defect that would result in its demise regardless of setting. 

Where did you go to school to become a midwife?

• Whether college or online, accredited or non, the school they attended is going to influence their birth philosophy. If they attended one that they no long ascribe to their philosophy hopefully they will make this known.

How many births did you attend before becoming a midwife?

• This is more important information relating to how experienced she/he is in birth.

How many births do you attend per month?

• If your midwife is in a solo practice, without another midwife who attends regularly with her, it's not wise to attend more than 4 births in a given month. The exception to this might be if she is at a birth center where more than one woman can come into the center to birth her baby.

Do you carry malpractice insurance? If no, why?

• Unless she is a CNM, midwives in PA cannot get malpractice insurance. Bear this in mind should something go wrong at your birth. You will have no recourse to collect damages. If this is important to you, do not hire a direct entry midwife, hire a CNM and birth in a hospital.

Do you have any medical conditions or mental health conditions that would influence your care of me?

• This is a big one. You may think you are prying or being too personal but you aren't. If you apply for any job don't they ask you if you can lift "x" amount of pounds, sit, stand, etc. for so many hours a day? For example, I have rheumatoid arthritis. I've had it all of my life. For the most part, it doesn't affect me and if I have achy days usually some aleve does the trick. My condition does not at this time, affect my ability to perform my job well. The mental health one is a bit trickier and if your midwife has a history of depression that may not preclude her from being a good midwife. If however she has NPD or is bipolar or has a personality disorder and is not receiving care, that can come back to bite you later. Unfortunately most people who have personality disorders don't think that they have one so you need to educate yourself on what the signs are.

Is homebirth as safe as a hospital birth?

• The correct answer to this is no. If you have a midwife who tries to make it seem like it is just as safe, do not stay with them. Homebirth has many perks and is generally less invasive than a hospital birth. Most of the time everything goes great. However there is no OR, NICU, blood products, pharmacy, or anesthesia available at a homebirth. So, if anything is amiss that can't be easily handled at home, you are not as safe as you would be in a hospital. If you are ok with taking that risk, fine, but beware the midwife who paints homebirth as safe or safer than a hospital birth.

Do you offer waterbirth? If so can I rent a tub? How many tubs do you have?

• Waterbirth is a great coping tool for dealing with labor pains. It can diminish, but not entirely remove, the birthing pains. If she is taking on multiple clients, she should have multiple tubs.

I'm an abuse survivor, are you experienced in supporting abuse survivors?

• If this doesn't apply to you then you of course don't need to ask it. But, if it does apply to you (one in three women it does), it is a good question to ask.

Are your currently certified in neonatal resuscitation and basic life support?

• Every two years these courses need to be taken for recertification. It can be difficult to find an NRP course but it can be done.

What types of emergencies have you handled at home?

• Common emergencies are shoulder dystocia, hemorrhage, and resuscitation of the newborn. Your midwife should have handled all of these competently at some point in her career.

What equipment do you bring with you to a birth? Do you carry herbs, medications?

• She should be able to rattle off a list of items that she brings including sterile instruments, doppler, stethoscope, blood pressure cuff, etc. Some midwives carry a small herbal formulary with them and some just a few or no herbs. Some carry homeopathics. Some are not permitted by law or do not feel that they should carry medications. Some carry them no matter the law because they would rather face the fine from the state than risk your life.

What was the last continuing education course or module that you took and when?

• For all certified midwives, continuing education is required to maintain their certification. For non certified midwives it is not, but is still just as important. The evidence and science behind obstetrics and midwifery is ever changing and it's important to stay on top of what the latest science says about care.

What does a typical prenatal visit look like?

• For a homebirth midwife, visits should not be rushed. At least a half hour and preferably and hour should be set aside to care for you and your baby. Vital signs, fetal heart rate, measuring your growing uterus, and assessing the position of your baby are staples of care. The rest of the time is spent on education, getting to know you and your family and developing a trusting relationship.

What prenatal testing do you require?

• There is going to be some differences here. Some midwives require all the testing, some want the minimum, most are somewhere in between. Waivers, education on types of testing, and informed consent on all testing should be offered.

Do you work with another midwife as a partner?

• In some practices there is more than one midwife. This is the ideal, but is not always available due to large geographic areas that are underserved by midwives. Also, not all midwives get along and would make horrible partners.

Do you have apprentices?

• Most midwives have an apprentice or an assistant that you will get to know over the course of your pregnancy. Find out who that person is (hopefully they came with her to the interview) and what her/his background is with birth.

Do you have a backup midwife?

• If she doesn't have one, be wary. What would she do if you and another client go into labor at the same time?

Do you participate in peer review? How often? How many midwives participate?

• Peer review is an important part of accountability and keeping good relations between midwives. Beware the midwife who only does peer review with her apprentices or partners. She is probably not getting a diverse perspective on her practice. In this age of facetime and skype there is no excuse for not having additional midwives in a peer review. If other midwives refuse to particpate in her peer review, something is amiss there. Midwifery is fraught with interpersonal infighting and politics so I can't say why that happens in every case but it's usually messy no matter the reason.

Are you the best midwife in the area?

• The answer to this should be "no", or "I don't know?" or "we have several great midwives in the area and I happen to believe I am one of them." Unless she says yes sarcastically (I'm known to have more than a touch of sarcasm.) of course that's different. A midwife who touts how great she is and puts down all other midwives as inferior has a goddess complex and isn't worth your time or money. A midwife should be sure of herself and competent but should not be boastful or brash. We are all human, there is no competition or award for "best midwife".

If you don't have malpractice insurance, and I am not satisfied with my care, who do I make a complaint to? 

• If she does not participate in peer review and is not licensed, you have very few options for lodging a complaint in PA. If she is a CPM, you can lodge a complaint with the North American Registry of Midwives. If she is licensed or a CNM you can lodge complaints with the board of midwifery or the medical board, depending on your state.

Do I have to hire a doula?

• Who you have at your birth should be entirely up to you. You are hiring her and while a doula is in my opinion, a worthwhile expenditure for your birth, it should not be required.

Do I have to take childbirth education classes?

• If you are a first time parent, this is a must do item for your list of things to do before the birth. Your midwife should have suggestions of courses to take and people with whom you can take them with.

What is your policy regarding children at the birth (if you have children of course)?

• Your kids live with you, they should be welcome in your house. It is fairly standard to ask that you have someone to care for your child other than yourself or your partner during the birth. Whether or not you want them in the house or out of it should be your choice unless something happens where their removal is optimal.

What is your preference regarding my pets?

• Some clients really love their pets. I get it. Some of you think they are your children. Especially those of you without actual human children. While I don't pretend to understand that, I get that it is a fact of life. None the less, pets at birth can be a very bad combination. Especially dogs or territorial cats. You will be making noise while birthing and you don't want your midwife to be attacked when she is helping you because your furchild believes that she is causing you to be in pain. Also, cats + inflatable tubs = deflatable tubs. Another thing, some midwives are fine with pets of all kinds and love them. Some don't for a myriad of reasons so if you are having your midwife come to your home for prenatals be sensitive to your midwife's needs as well.

If I am sick, do you have a physician that you can refer me to or should I see my family physician?

• CNMs have prescription privileges and can likely write you a script for what ails you. Other types of midwives legally do not have this authority. They may however have a collaborating or sympathetic doctor that they refer moms to. If your midwife states that she has a collaborating or backup physician, don't take her word for it. Call and ask the physicians office.

Do I need to have a pediatrician lined up before the birth?

• Yes, yes you do. A homebirth midwife is not a pediatrician. Even a CNM is not a pediatrician. You should secure a pediatrician and find out from them how soon after the birth they want to see your baby. This varies from pediatrician to pediatrician but most want to see the baby within 48 hours of the birth.

Do you carry resuscitation equipment with you for the birth?

• They need to carry at the very least an infant bag and mask. There is debate about the safety of oxygen use during labor and delivery. Room air is generally used for resuscitation except in the hospital where they have a special oxygen mixing machine for resuscitation. So your midwife may or may not carry Oxygen.

Do you "trust birth"?

• If your midwife is a "trust birth" midwife. Please don't hire her. Respecting birth and believing that women can safely birth their baby most of the time without interference is not the same thing as blindly trusting the birth process. I used to be part of the "trust birth" movement. I'm not proud of this. It made me reckless and I didn't even realize it. The "trust birth" movement has harmed so many families and midwives. Stay away.

Are you a hands on or hands off midwife?

• This one should be conditional. A good midwife knows when to back away and observe, hold the space, and not interfere. She also knows when to jump into the fray to prevent disaster to the best of her abilities. She should not be inflexible when it comes to this. Some women want more support physically from their midwife and some don't like to be touched or spoken to. You're the boss, but she is the supervisor of the health department so to speak in this working relationship.

Can I have access to my chart and test results at any time?

• It's your chart, they are your results. You should be able to access this information when needed. If your midwife does paper charts, you should be able to have copies when requested. If your midwife does electronic charts, you should be able to access your chart online.

How often do you transport?

• This answer should not be never. Transport is not a failure. Not transporting when needed is a bad idea and can end in catastrophic loss. Transporting during or after labor is not a failure. If they have more transports than home deliveries that can signal that something is wrong as well. A decent rate of transport is around 10-20 percent. Any more than that might show a failure to screen out higher risk women.

What happens if I want to go to the hospital, for any reason, during labor?

• The answer for this should be. We go to the hospital.

Who is most likely to transport in your practice?

• Some midwives leave out the fact that first time moms and first time vbacs typically have longer labors and higher rates of transport. Most transports are for non emergent reasons to get pain relief or for further assessment of a baby who shows signs of potential distress.

What is the most common reason for transport?

• Usually, as stated above, it is maternal exhaustion. However, some midwives place the onus on a transport as the mother's fault. A mother doesn't make a transport happen. It usually just happens through nothing that she did at all, unless of course she requested it.

Are you able to accompany me to the hospital if I need to transport? 

• This is going to depend on the midwife, the state that you live in, and her relationship with the area hospitals.

What is your standard of care for: breeches, twins, vbacs, vbamcs, GBS + moms, past 42 weeks of gestation, prior to 36 + weeks of gestation, prolonged labor, meconium, maternal fever, herpes, prolonged rupture of membranes, vitamin k, eye ointment?

• There is a lot in this question, but it should be discussed at your initial consultation or in the first email that you send to your potential midwife. Some of those things may not be applicable for you (If you don't have herpes and are a first time mom you don't need to ask about vbac or herpes for example.).Truly all of it should be in her informed consent documents. Some midwives are comfortable taking more risks than others. This is not always a good thing. No homebirth midwife is an expert in high risk mothers. Only CNMs, OBs, and perinatalogists in hospitals can stake such a claim. Any homebirth midwife that says otherwise is practicing foolishly and boasting of a title that is not available to her. There are inherent risks in all of the above situations. Some you may be comfortable with (like a vbac after one section) and some you may not be or you may not know a lot about. If you aren't aware of the risks, ask her, and then double check what she says later. Another example would be breech. Some midwives have a lot of breech birth experience and others like myself, have none. While it's true that many breech babies can be born vaginally, you want a provider who has experience in that mode of delivery attending you and you need to be completely informed of the increased mortality and morbidity risk involved. Unlike the popular slogan, breech is Not a variation of normal. Breeches occur 3-4% of the time in all births, including multiples. If something occurs only 3-4% of the time then it does not fall under the heading of "normal".

Can you guarantee me that I will have a homebirth with you?

• There should be no hard and fast guarantee. We cannot foretell the future. Any midwife who boasts otherwise is a fool and is likely to take chances with you and your baby.

I've been told that I'm too high of a risk to homebirth by other midwives and my obstetrician. Will you attend my homebirth?

• I shouldn't have to say this, but if you have had other midwives tell you that you do not qualify for a homebirth, then you shouldn't plan on a homebirth. I see this sometimes with moms who have had multiple surgical deliveries in particular. Years ago I did vbamc at home without batting an eye. (thanks "trust birth"!) I no longer offer this unless the mom has had a prior vaginal birth after c-section and even then they must be getting co care with an OB or CNM.The only rupture I have witnessed was to a mom who was attempting a vba2c. I transported as soon as I suspected a problem, we were at the hospital for a few hours after the transport and when they finally did a section, she had ruptured. She lost her baby. She almost died on the table. She would have died at home. I won't go through that again. I won't take that chance with anyone again. If you are that dead set on a vaginal delivery at home then please do us midwives a favor and have a UC. If you want to take risks, fine, but leave us out of it because we will face the legal repercussions if something goes wrong.  So please, if you want a vbamc, hire a doula, don't consent to a repeat section at the hospital, insist on a TOLAC and birth in a hospital. It's sad that women have to fight for that, but a vbamc is best monitored and handled in a hospital in my opinion. Same goes for special scars vbacs.

How do you monitor my baby and myself during labor and how often? 

• All midwives should carry a doppler and fetoscope with her to births. Intermittant monitoring at regular intervals (every 30 minutes, then every 15 as labor progresses, then every other contraction) is the best way we have at a homebirth to monitor your baby's health. Asking you if you can feel the baby moving is helpful, but is not definitive. Both are pieces to the puzzle and both are important to know.She should also listen a few times during your birth during a contraction to determine how the baby is handling contractions.

How often do you do vaginal exams?

• There are often two extremes to this. Midwives who refuse to do them and midwives who do them like clockwork, every two hours. A mother should always have the right to both request an exam and to refuse one. Midwives should be capable of doing them and know when it is time to check and when it is time to wait.

Do you do delayed cord clamping?

• Most midwives do this at a homebirth and it should be standard of care.

How long can I wait to birth my placenta?

• This is often situational as well. It depends on your bleeding, how well you are contracting, and how you are feeling overall. Most placentas will detach and can be birthed within the first 5-15 minutes after the birth. Some come out earlier, some a bit later. A retained placenta is considered one if it has not detached and birthed after 30 minutes. I have waited longer than this, if the moms uterus is clamped down tightly and there is no bleeding, but at some point a hospital transfer is likely should the placenta not come. It's not meant to stay inside after the birth of a baby.

What happens to my placenta after the birth?

• The placenta is yours so you should have a say in what happens to it. Some moms want to keep it, some want to have it encapsulated, some want to plant a tree over it, some don't want to see it, some just want it chucked into the trash.

After the birth, how long do you stay?

• Some midwives stay a very short period of time, but generally they stay between 2-4 hours after a birth.

When do you come back after the birth?

• This is also going to vary, but generally most midwives come back within 48 to 72 hours after the birth, again at two-three weeks, and again at six weeks. Some CNMs in particular do not do the 2-3 week appointment.

What do you expect from me during my pregnancy, birth, and postpartum in terms of responsibility?

• Homebirth and birth center birth and hospital birth all have their own unique frameworks to navigate. I wrote earlier of how the safety and both home and birth center births have higher rates of morbidity and mortality than hospital births when we look at national statistics. This is true regardless of type of provider. If you are choosing to have a homebirth, with an unlicensed provider or a licensed provider, you are taking on a great deal of the responsibility (barring outright willful negligence on the part of your midwife of course) for that decision. This is both the beauty and the hard reality of out of hospital birth. You are the one in charge, no one makes you have a homebirth. You sought this out, educated yourself, interviewed several midwives, went to an obstetrician or family doctors office at some point, and decided that being at home was where you felt that you needed to be. If you have a midwife who coerces you into having a homebirth or paints it as risk free then she can be held culpable as well should things go badly. 
• You should be responsible for being honest and forthright with your midwife about any changes in your health.
• You should be responsible for eating healthy and keeping your stress levels to as low as possible during pregnancy.
• You should be responsible to maintain a low or moderate exercise regiment.
• You should be honest and forthright about any changes in your mental health.
• You should be honest and forthcoming about any drug use.
• You need to keep a tidy home and clean space for birthing.
• You need to purchase a birthkit or misc. items contained in a birthkit by 36 weeks of pregnancy.

Do you have payment plans?

• Most midwives do and that possibility should be listed in her financial agreement.

Do you offer refunds and if so under what circumstances?

• Again, this should be in the financial paperwork, but at the initial interview it is a good time to get all of the business side of things cleared up.

Can I contact some of your former clients for referrals and can I talk to at least one that you had to transfer care?

• It's important to include that transfer client. Those are the clients that are most likely to not have had as good of an experience. However, if the client seems happy with the decision to transfer and feel that they were a part of that decision, that makes a big difference. Realize that the midwife is not going to give you names and numbers of disgruntled former clients. This is because A) they may make her look bad and really who is going to admit to that and B) sometimes disgruntled clients aren't happy in spite of her best efforts and due to privacy laws she can't defend herself to you.

What is your preferred method of communication?

• Some want a phonecall, others a text or email. Most it is a combination depending on the situation. Please do not abuse this with your midwife. If it is a non emergent situation, please wait to call or text us until normal business hours. We sleep with our phones next to us and although we may sleep through your text...we likely will hear it beep and check in case it is urgent. While your heartburn or restless legs may be keeping you up, it shouldn't keep us up. Google can be your friend or please call in the morning and we will give you suggestions.

For yourself, after the interview: Talk it over with your significant other or support person and get a feel for how comfortable both of you were with the midwife. Do your due diligence and check up on any subject matter that came up that you were unsure of. Remember that you are your unborn child's best advocate!

Children at birth

Involving kids during pregnancy makes the process less overwhelming.

I Love having  kids at births! I really do.I have heard that there are some providers in hospital and out that are less than thrilled with their presence at birth and prenatals, but that is a shame. If you want to have your child as part of the experience, I'd encourage you to stand up for your rights to include your family or if not please change providers.

The video below is a homebirth I attended several years ago where there were lots of bystanders to this mama's labor and birth. Her children, her husband, her mother and father, and her sister were all there in the house while she labored. Now, they weren't all in the room with her when she birthed, but they popped in and out periodically. Her sister was a photographer and took the lovely photos that make up the collage in the video. Her family respectfully and quietly inquired how she was doing and asked if anything was needed to be done by them to help? Her children came in and out, and if they were being too boisterous, a family member came and took them downstairs to give their mama space to labor in.

Some moms wouldn't want all of those people around her. I would even say that most moms need lots of privacy, space, low lights or even darkness as they labor to bring forth their baby. This mama needed lots of support, but not necessarily support from others in the same room during her whole labor. 

What I see as working best with parents who involve their children at births is a few things:

An apprentice of mine and a client, during a prenatal.

1- The Parents spend a lot of time prenatally involving their older children in the pregnancy and birth process. A good way to do this is to bring them to prenatal appointments.

2- The Parents show their children books, birth videos, even take them to childbirth ed. classes with them to prepare them for the birth.

3- The Parents answer every question honestly and don't sugar coat the realities of birth.

4- The Parents have another support person at their birth whose sole responsibility is taking care of the children.

5- The Parents allow their child to not attend the birth if the child is asleep, scared, or suddenly not interested, even if they were before.

Now here is why I think those five things are important:

Number one: because having your child come to appointments take some of the unknowns out of pregnancy and birth. They get to know what a doppler is, a fetoscope, tape measure, blood pressure cuff, etc. and what they are used for. They will get to know your midwife or other birth professional and this makes that person someone that they trust instead of someone who just shows up out of the blue and starts poking and prodding at mommy (even if that isn't what is actually happening, it could be perceived this way). This also helps your midwife and birth team get to know your child and their personality.

Number two: because children are sponges, even at toddler ages, they love to learn! What is going on with their Mommy is exciting! They want to know about Mommy's expanding belly and how big the baby is getting inside of her. Nine months to them seems like such a VERY long time! Reading books and watching videos about pregnancy and birth helps to answer their questions and show them the realities of birth.

Number three: because honesty is always the best policy. Using proper terminology of body parts, tell the child what is going to happen during a birth. Tell them about mommy's expanding belly, how her breasts will make milk for the baby, and that the baby will come out of mommy's vagina. You should also tell them that sometimes mommy needs some extra help and she may need to have a surgical delivery. Let them know about bodily fluids, sounds, and smells that they may see during labor and delivery.

Number four: because during labor, the mom needs to focus fully on herself and her new baby. She is doing a fierce work and needs to stay in "laborland" as much as possible. Having a support person there who can get the child a drink, snack, put them to bed or just entertain them is essential to allowing the mom to stay in the moment and not get into "mommy mode".

Number five: because children deserve respect as well. If you child is tired, let them sleep. If they get scared or change their mind, let them relax somewhere else.

Another great reason for involving your child in your pregnancy and birth is because it is the perfect way to educate them on the process. In our modern society, children often go their whole lives not really knowing what is involved in pregnancy, labor, birth and postpartum. Take the mystery out of these events and include your children!

Duggary Buggary

Unless you live under a rock, chances are you have heard about the Josh Duggar debacle. Josh is the oldest of the 19 children of Jim Bob and Michelle Duggar. He is also the now former executive director of FRC action. FRC action is the legislative branch of the Family Research Council. 

In a nutshell (though I included the link to the original story above), Josh molested four of his younger sisters and one other girl from another family.  He was 14, 15 at the time. His youngest victim was 5.  He fondled their genitals, buttocks, and breasts, usually while they were asleep but sometimes while reading to them. The Duggars are part of a Christian fundamental Baptist sect with ties to Bill Gothard and the Patriarchial wing of the Quiverful movement. In true Fundamentalist fashion, the abuse was not reported to the proper authorities immediately and therapists specializing in sexual abuse were not acquired. Jim Bob and Michelle first went to their church family about the situation nearly a year after they were made aware of what was happening. The abuse was then told to a family friend after a year who was a police officer. This police officer gave Josh a "stern talking to" and no formal charges were filed. Josh was then sent to work on a church members house to do a few months worth of remodeling as penance for his misdeeds. His statement says that he received counseling and that his victims did as well. 

"Twelve years ago, as a young teenager, I acted inexcusably for which I am extremely sorry and deeply regret. I hurt others, including my family and close friends," Josh, 27, tells PEOPLE in a statement. "I confessed this to my parents who took several steps to help me address the situation. We spoke with the authorities where I confessed my wrongdoing, and my parents arranged for me and those affected by my actions to receive counseling. I understood that if I continued down this wrong road that I would end up ruining my life." 

Notice the last sentence. "I understood that if I continued down this wrong road that I would end up ruining my life." He understood that he would end up ruining his life. Not his victim's lives, his life. While his actions may not have "ruined" his victims lives, they certainly impacted them negatively, forever. This part of his statement is very telling of the selfishness and entitlement that this young man still has.

I'm reminded of a scene in True Blood where Sookie is intimate with Bill for the first time, and she has a flashback to a time where her uncle fondled her as a child and it interrupts the mood. She relates to him about the incident and tells him that she can't help it, that she can still feel him touching her when Bill touches her and that she hates that. Bill holds her close and tells her that she is safe with him, that he is honored that she would share herself with him after that happened to her. I realize that True Blood is fiction, but the scene is commonplace for abuse survivors. That scene struck a chord with me when I saw it several years ago because that is a very real struggle for those of us who have sexual abuse in our past. Sadly, I can confirm that this sort of thing happens to me quite often. I don't always express it to my husband, because by now I am so used to it that I brush it aside and go forward, knowing that that feeling will subside or dissipate most of the time. If it doesn't, I let him know and we stop.

And then Bill has him some Uncle Pedo as a snack later.

I think of those little girls in their beds at night before it was all revealed, the fear that must have gripped them nightly, wondering if their brother would be visiting them again? Then I think of when it was revealed to the parents, and how they momentarily may have thought that something might be done, only to have to endure Bill Gothard style counseling where they were asked what they may have done to entice their brother to sin and then asked to repent of that. I imagine these things, and imagine how they were made to forgive him because not doing so would be a sin, and I am so sad for those beautiful little girls. I am angry at their parents for not protecting them from their abuser, for making them continue to live under the same roof with him when he was not getting proper counseling.

I have had some people ask me why we shouldn't forgive him of this mistake. After all, we all make mistakes as kids, as teens, and we don't want that to follow us our whole lives, do we? There are some big problems with this logic.

First, this was not a "mistake". This was five different girls, all of whom were more than three years younger than him (Arkansas state law states that if the victim is three years or more younger than the perpetrator, then it does not matter the age of the perpetrator or if they are related, they have committed a crime.) Penetrating or parting the labia is considered sexual assault in Arkansas, as it should be.Therefore, Josh is a criminal. A criminal who his parents protected above their daughters. A mistake is smoking in the boy's room at church. A mistake is doing this maybe once, with one person, realizing how awful it is that you did that, and never doing it again. A mistake is shoplifting candy from a store. A mistake is playing hooky from class. This was not a mistake. This was a predator, even though he was young, preying on young girls for his own sexual pleasure and curiosity.

These dresses, those are mistakes, yikes!

The next thing that has been brought up is what would you do if this happened in your family? What if it were my son? I can answer this, quite honestly, being the mother of five boys and one daughter. I would call the police on my son if I found out that he had been molesting his little sister and had done it to four other girls as well over a period of nearly 2 years. No questions about it. I might not even call, I might simply take him down to the station. It would be hard, it would be heartbreaking. I would go to his trial if there was one, I would agree to let him get whatever treatment that was offered. I would not bring him home. He would either have to go into the system or go to a relative's house. He could not come home with me, maybe not ever again. Most likely not ever again. I would always love him, but I would not support him like I would my other children. I would get my daughter therapy and would not expose her to her brother ever again unless she specifically requested it.

The last thing I have heard is that this happened over a decade ago. So? Your point is? When it happened is immaterial. In fact, if anything the fact that it happened before the show was signed into contract but they kept that a secret while portraying themselves as living the ideal christian life is disgusting. This one is tied in with a "poor Duggars, they forgave Josh a long time ago now you are persecuting them and exposing his victims!" Just stop. I'll address the forgiveness angle a bit later. I'm not persecuting them and no one else is either. They should be called on this abysmal behaviour. They should be exposed for the frauds that they are. Christians should not back up other Christians who break the law so blatantly and who so fundamentally disrespect women like this group does. These people are hypocrites who won't let their daughters go on a date alone or kiss before their wedding day but make them stay in a house with a known child molester.

People are having a hard time seeing a 14, 15 year old boy as a criminal. I get that. He was a teen, he was not a man. He was also sick and did not get help. He now has little girls. Let that sink in. He is now a grown man with daughters the age of some of his victims. Repeat offenses are low in young people who get help with pedophilia, the same can not be said for those who do not get help. If anything, the way this was handled would have helped him to see how to better hide what he does and then how to get out of it if he is discovered.

Too soon? Michelle Duggar did a robocall trying to get people to vote against allowing transgendered people to use the bathroom of the gender that they identify as, because they might sexually assault your child. 

The revelations on Josh Duggar were not particularly shocking to me. There have been rumors about this possibility circulating the internet for years. I haven't addressed them before because they were just that, rumors. I'm not interested in rumors, I'm interested in facts. 

I'd suggest reading the following links:
http://www.patheos.com/blogs/lovejoyfeminism/2015/05/what-you-need-to-know-about-the-josh-duggar-police-report.html

and
http://www.patheos.com/blogs/leavingfundamentalism/2015/05/22/josh-duggar-apologised-so-what/

and the best timeline laid out simply here
http://defamer.gawker.com/the-web-has-known-about-josh-duggar-for-years-when-did-1706258269

I'm not going to link to the moronic supporters of the Duggars. And yes, if you are supporting Josh, or defending the inactions or actions of his parents, you are wrong for doing so. I'm talking to the Matt Walsh supporters, the Huckabee backers, the  Ron Comfort sympathizers. You are supporting people who think it's ok for Christians to cover up sexual abuse.

What bothers me about all of the people who want us to forgive Josh Duggar and want us to stop "revictimizing" his victims, is that they obviously don't understand the severity of what sexual abuse does to women. They don't understand the culture of purity that is inherent in the Fundamental church and how it permanently damages those of us who survive it even if we aren't sexually or otherwise abused. They don't understand fully how dangerous the Patriarchy within these sects is and how women are not permitted to feel anything but happy. Keeping the abuse a secret was the re victimization, not the revelation necessarily. I wish that one of his victims had been the ones to tell this tale, but that is not how it works in the fundamental Christian world. I am not happy that the way this was revealed meant that we know who his victims were without their being the ones to tell it. That doesn't seem fair, but it's better for lies to be exposed than buried.

this might be unfair if we didn't see it so often...

I believe that I have touched on this before, but anger is simply not permitted in the fundamental sects of Christianity where patriarchy is the rule. Sadness is a sin. Trauma is a reluctance on the part of the person having gone through it to accept God's grace and peace.

The other thing that bothers me about people wanting us to forgive Josh Duggar is that it is not our place to forgive him. He didn't wrong us personally. His victims may forgive him, but we shouldn't be expected to do so and to say that we forgive him is a slap in the face to his victims.

I am very suspect of the validity of the forgiveness that his victims purportedly gave to him. Remember that within quiverfull fundamentalist families such as the Duggars, to not forgive is a sin. It is very simply not done. 

The Duggar girls would have been given Gothard training materials from ATI on this subject, training materials that very explicitly put blame on the vicitims of sexual abuse as well as on the perpetrator. The page below is from Gothard's ATI, which is where Josh and the Duggar girls reportedly went for counseling. Now, apart from the obvious theological problems with this (gnosticism is what it looks like to me, more than Christianity with the spirit thing at the center, but I am off topic with that), the blaming of the victim and the requirement for forgiveness is evil. Pure evil.

Let's go back to that robocall, shall we? Here's what Michelle Duggar said in that call: "Hello, this is Michelle Duggar. I’m calling to inform you of some shocking news that would affect the safety of Northwest Arkansas women and children. The Fayetteville City Council is voting on an ordinance this Tuesday night that would allow men – yes, I said men – to use women's and girls' restrooms, locker rooms, showers, sleeping areas and other areas that are designated for females only. I don’t believe the citizens of Fayetteville would want males with past child predator convictions that claim they are female to have a legal right to enter private areas that are reserved for women and girls. I doubt that Fayetteville parents would stand for a law that would endanger their daughters or allow them to be traumatized by a man joining them in their private space. We should never place the preference of an adult over the safety and innocence of a child. Parents, who do you want undressing next to your daughter at the public swimming pool’s private changing area?" 

One sentence in this also stands out to me. "I doubt that Fayetteville parents would stand for a law that would endanger their daughters or allow them to be traumatized by a man joining them in their private space." Oh really Michelle? Didn't you endanger your daughters and allow them to be traumatized by a young man joining them in their private space?

The lion's share of the blame in this situation rests with Michelle and Jim Bob Duggar. It also rests in the Fundamentalist and Quiverfull patriarchy mentality that they follow. Blame can squarely rest on Josh's shoulders since he is the actual perpetrator, but at the same time he is the product of his environment and was not given help. When you worship the god of purity, chastity, modesty, and fertility and claim that those gods are the proof and measure of the real God, you will reap what you sow. And what you sow is sadness, hypocrisy, and corruption.

Doc died...

He passed away on Tuesday of this last week. The day that I was assisting a mama as she was working hard to bring a new life into this world, the world was becoming a better place without this villain on its surface.

It's interesting to me, the ebb and flow of life and death. The yin and yang, the good and evil that keeps the world either balanced or out of sync, depending on which is stronger and more prevalent at the time.

I haven't mentioned his actual name on this blog, and I'm not entirely sure why?

Perhaps it was out of respect for his family, as I hold his children blameless? 

Perhaps it was out of fear, that if I spoke it aloud, that I would get in trouble for slander?

Perhaps it was because even now, many years later, I still harbor a part of my psyche that dares not speak all?

It matters not. He's dead. I will see no justice in this life for what he did to me.

My husband and others have tried to reassure me this week that now that he is gone, he is burning in hell. Or in purgatory, or somewhere not so nice as God is a God of justice, so they say.

I admit, I'm not so sure. Being human, and never having seen justice in this realm meted out by this all knowing God or His subjects, I am not reassured of his ability to do it in the next life. I wish I did not have these doubts, but I am simply putting this out there, to be honest with all.

But I do know this. I now feel that I can say his name.

Dr. William H. Anderson M.D., jr.

Here is his obituary: http://www.legacy.com/obituaries/erietimesnews/obituary.aspx?n=william-h-anderson&pid=174645076&

There is, of course no mention of his sexual sickness. No mention of him being a pedophile. No mention of him being a rapist.

There is so much there of all of his good works, his community service, and all of his larger than life accomplishments. Names of family gone on before, like his wife, Wanda, who I suspect knew something was going on. And Billy, sweet Billy who I loved so very much. Mention of his other children, and numerous grandchildren and great grandchildren.

And all the while I wonder...did my silence allow him to abuse more children? I have a bad feeling that perhaps it did. I have wondered that for years. I feel guilt, and remorse for that. Granted, I was given very bad advice from my Pastor who told me that the statute of limitations was up seven years after the last incident, which would have made me just shy of 20. So for many years I thought I didn't have any recourse against this evil man. It wasn't until I was in my early 30's that I discovered that I had until age 30 to press charges.

I could have done something different, had I known. Pastors really shouldn't be giving out legal advice, especially when it only benefits them. Keeping abuse secret in the church is so much less messy than admitting how many sick perverts they are hiding amongst themselves.

I was reading on another site about how others have processed the information that their abuser passed away. It seems that a myriad of feelings and approaches are the "norm" so all the weirdness that I have felt this week is certainly not abnormal. I am relieved that he's gone, happy that he is dead, and yet I feel a great sense of loss that he isn't here anymore for me to possibly get some closure from.

That last feeling is the greatest. I am not grieving him at all. I hope that he died horribly, though I doubt that he did from what I read in his obituary. It doesn't seem fair, that he lived to a ripe old age, surrounded by loving family in his final years. But, life does not deal in fair, it is just life.

So now...where to go from here, what to do with this information? That is what I wrestle with today.

I kind of wished that I lived closer to him. I oddly would have liked to go to his funeral. I honestly thought about it on Thursday, computed how many hours it would take me to get there from here, where I might possibly stay, etc. But in the end, I decided against it. I didn't even verbalize this thought, as it seemed a waste of time and money...and to what end? I was thinking about it simply because I wanted to see that he was actually dead, to see him lying there, much smaller than he was in my young mind when he was so large and abusive. But no...I do not need to do that. I know he was not as big as I remember him, not as powerful, he was just an asshole. A manipulative master of little children, that is what he was, and that is a small, ridiculous person who is not worthy of my time or effort to prove that he was what I know him to be.

I read one person who talked about writing their abuser a letter after their death. I read another who talked about rewriting their obituary to include the details of the abuse. I kind of like both of these options, and may still do one or the other.

I tried to think back and remember good times with him, and the first ones that came to mind were kind of humorous. I remember the time that he pierced my ears and I kicked his shins as hard as I could with each ear, knowing full well that I would get away with it in that setting. I remember playing chess with him, him beating me at the first game in a classic set of moves called, "fools mate" and then my solidly beating him the next two games. He never played me again, he had been bested by an eleven year old and his ego couldn't handle that. There were picnics and birthdays and Christmas get-togethers where we all enjoyed each others families. Those times were the times when he and I pretended like nothing was going on, where I would have to hug him or kiss him or both to say hello or good-bye. So really those times were not so good, I just pretended that they were and he enjoyed the innocence of my family's good will in not knowing the evil that they hosted beneath their roof or enjoyed in his abode.

But mostly I have decided to honor not his life, but mine. I survived. In spite of him, I lived through that. He tried relentlessly to break me to his will, and to an extent, he succeeded. But ultimately, I overcame. I made the best of a horrific situation. I look back now and I am amazed by the resiliency of that little blonde girl who had very little and no support from anyone, even after she told her story. I definitely engaged in some very classic abuse survivor behaviours as a young adult and teen, but ultimately I made my own path and pretty much gave him the proverbial finger. 

And in this post, I give it to him again. I'm outing you Doc, I have nothing to lose now, and you certainly don't have any way to hurt me anymore.

If you were abused by this man, know that you were not alone. I believe you. I know who he was. I know he was brilliant. I know he gave back to his community. I know he was a healer. I know he gave so much to many in need. I know he loved his family. I know he loved his church. I know he professed to love God. 

I know this above all. He was a lying, sick man who like to have sex with children. He probably went above and beyond in so many other areas to try and make up for being such an awful person behind closed doors. I really don't care how many lives he saved or made a difference for, because he killed me. He killed whatever I was before and I had to be reborn into a stronger person to survive. I don't know what I would have ended up being if he hadn't been a factor in my formative years? I doubt that I would have nearly as many issues with trusting people and with trusting God. But I do know that I will use my story to help others, to give a voice to the voiceless.

I also want to say thank you to all who have posted words of support to me on Facebook and in other messages. I needed that. I appreciate the love and although it saddens me to hear from so many that they too endured abuse, it also makes me realize just how important it is to voice our doubts, fears, and moments of triumph over our pasts, presents, and futures.