So in honor of International Day of the Midwife, I thought I would describe a little bit about how awesome midwives are and a little bit about the difference between obstetric care and midwifery care.
When I was first practicing in 2005, when I told people what I did they would sometimes give me a blank stare and ask, “what is a midwife” or “those are still around?”. The lack of understanding made me feel like the world had a long way to go towards recognition of midwifery. Happily today, I almost never get that blank stare. People are sometimes a little shocked when I tell them I attend homebirths but not nearly as much as they were 7 years ago.
I have to confess that until recently I suffered from a common midwife problem of believing that the work we did was somehow “less than” that of obstetrics, that what we had to offer women was not as authoritatively “good”. Even though our care is woman centered, and even though it is very personalized, and even though the safety for low-risk women in a homebirth setting is comparable to that of a hospital birth, I still felt that “less than” status.
Recently though I have come to realize that my knowledge base is no less “good” than that of an obstetrician, it is just that my area of expertise is different. Reading Ina May Gaskin’s Birth Matters was life changing for me. In her book she discusses the evolution of the obstetric profession and how at first they had difficulty in convincing women to use male obstetricians in their births. The doctors realized that in order to get women to seek out their services they had to scare them (and more specifically their husbands) about birth. They had to make their methods (not at all based around physiologic birth) seem attractive and somehow safer. Obstetricians learned about pregnant women from studying cadavers, not by observing women in their labors and births.
This really gets me. That the “profession” of obstetrics was basically created out of thin air and not at all scientifically or empirically based. That this “profession” continues to be revered as the epitome of care in childbirth. That what is still done to women (having normal births) routinely in the hospital is based on opinion, mythology, pathology and what some famous obstetrician said 85 years ago. That the positions that women are still forced to assume in birth take into account only the comfort of the physician not that of the laboring woman.
I do not want to ignore the fact that obstetrics has made amazing strides in saving moms and babies in pathological situations. The relative safety of the cesarean is a prime example. The epidural is another. When I am helping a mama whose pregnancy or birth is no longer within a comfortable range of normal we seek out the help of obstetricians and I am forever grateful for their care of the moms who can no longer be at home. But when the pathological model with which obstetrics views birth is applied to 80-90% of the birthing women in our country, we are not making the best use of our resources and most women in the country are not experiencing care that optimizes their chances of having a straightforward physiologic birth.
So midwifery care (for those of you who don’t know) is centered around the principle that birth is a normal physiologic event in a woman’s life. That most births, when untampered with, will go just fine. Midwives take care of women who are low-risk and are experiencing an normal pregnancy. Midwives continuously monitor for signs that things are not normal and will refer to another provider women who are no longer within an healthy range. Midwives put women at the center of their care and provide care that looks at the whole woman, her support system and her life circumstances. The midwife will help a woman navigate whatever challenges are facing her in her pregnancy. During birth, midwives monitor mom and baby for wellbeing and monitor labor for progress and can help when things are not progressing. Midwives respect a woman’s knowledge of her own body. Midwives believe that women know best how to birth their babies. Midwives are with women.
I am proud to call myself a midwife. I love my work and I feel lucky every day that I have amazing women who humble me and continuously show me how to be a better midwife.