Cockrell has lived in West Texas for twenty years and has been delivering babies for fourteen. She opened West Texas Birth Services, in Odessa, in 2001.
My mother gave birth to my younger sister when I was sixteen. They induced her at forty weeks, and I was present for the birth from beginning to end. The interventions I saw at the hospital created a huge memory in my mind, like the episiotomy. As a sixteen-year-old who was just learning the value of that area, it was pretty dramatic. My mother also had a postpartum hemorrhage. From that point on, I knew I wasn’t going to have kids. But then I got married, and four years later, I was pregnant. I said, “I’m having this baby at home.”
My firstborn was delivered in 1994 with a midwife from San Angelo, Lydia Dillard. It was a beautiful experience, but I knew it could get better. So six months later I began teaching natural childbirth and joined a small midwifery school, and in 1998 I enrolled in the Association of Texas Midwives training program. I apprenticed with Lydia for four years and cross-trained at different birth centers, including Casa de Nacimiento, in El Paso. So I was helping deliver babies, babies, babies until I got my license in 2001 and became a nationally certified professional midwife, or CPM.
I started West Texas Birth Services the same year. My practice serves all of West Texas, as well as eastern New Mexico. I used to drive sixteen-hour days going to all my mothers, but I’ve cut back now that I homeschool my four children. Right now I have twelve mothers, but there have been years when I was working with forty. I don’t keep an ob-gyn’s schedule; I see my mothers frequently. They come to my office every two weeks until they’re 37 weeks along, and I go to them until they’re 6 weeks postpartum. Each visit lasts about two hours.
When a woman calls and says she wants to have a home birth, she comes in for an interview. We talk about her medical history, and she signs an informed-consent form. If you hire a doctor, you hire the school that taught him, and it’s the same with a midwife: You hire the school that taught her, so you have to understand the philosophy behind midwifery. Midwifery is not the practice of medicine. We don’t diagnose or treat disease. We don’t do C-sections.
I also do a risk assessment. I tell her how many babies I’ve delivered—210 and counting since I’ve been licensed—and why I might transfer her to a doctor’s care. I don’t deliver twins, for example, though I do support midwives who do. I transfer care when I see things veering out of the realm of normal, like if a woman has a urinary tract infection that won’t clear up with natural remedies or if she has cardiac issues. Right now, about 6 or 7 percent of my moms end up being transferred.
The type of people who are drawn to the midwifery model of care want someone who’ll be patient with how the body works. So when I get the call that a mother is in labor, I go over and quietly check on her. If she’s not huffing and puffing and is less than four centimeters dilated, then I know it’s early. About 95 percent of my mothers give birth in water, so I’ll ask the fathers to set up the birth pool at 37 weeks so that she can use it to relax and get ready. Unlike at a hospital, the mother gets to eat and drink to her satisfaction. We want her to walk around, to take a shower, to rest. We want her to have romantic time with her husband, maybe go on a walk together. We don’t want her to feel like a watched pot.
Labor isn’t as dramatic as it is on TV. My mothers don’t push until they have the overwhelming urge to push. The famous midwife Ina May Gaskin describes how a cervix, the baby door, can open and close because it’s a sphincter, a muscle. Nobody tells you to poop and then you do it. So why do we do that with birth? I talk mothers through their questions and tell them to listen to their bodies. Pain tells us what to do, so if it hurts to lie on your back, then you roll over to your side or you stand up or you get in the water. Mothers with more-controlling personalities tend to control their labor a bit more. Mothers who don’t won’t usually labor as long. A good midwife has to be okay with being out of control and with mothers who yell.
I have never lost a baby or a mother, but I know the reality is that not all births end well. That’s why we have protocols in place and why we work with physicians. I’m a midwife who likes doctors; I turn to them to be surgeons and to help my mothers who are in trouble. When I do transfer a mother to the hospital, I don’t go in as a midwife but as a doula, someone who is just there for support, because I don’t have hospital privileges. One particularly harrowing transport involved a mother who gave birth to an eleven-pound, five-ounce baby—her husband was a dietitian and had maybe been pumping her with too much good food. The baby came out depressed, so I did a full resuscitation and transferred the baby to the hospital by ambulance.
Anytime I have to make a transfer, I could be complained against. I’ve had two complaints from physicians, both involving vaginal births after cesareans, or VBACs, and I’ve had to travel to Austin to justify my actions to the Texas Department of State Health Services. I don’t feel ashamed about being asked questions; I welcome them. But I’m at a crossroads right now: Do I keep taking VBACs and risk taking