A midwife is a trained professional with special expertise in supporting women to maintain a healthy pregnancy birth, offering expert individualized care, education, counseling and support to a woman and her newborn throughout the childbearing cycle. A midwife works with each woman and her family to identify their unique physical, social and emotional needs. When the care required is outside the midwife's scope of practice or expertise, the woman is referred to other health care providers for additional consultation or care.
~ Citizens for Midwifery
The moment when I first experienced a “calling” to midwifery lasted, in actuality, an entire weekend. Time stood still while something deep and ancient bubbled up and out of me as I sat in the passenger seat of our car, staring at beautiful coastline during a drive to northern California with my husband.
While I had yet to become a mother at the time of my epiphany, I had always known that I would someday aspire to become one. A theme throughout my childhood was a fascination with women’s bodies and birth. My favorite book as a pre-schooler was Where do Babies Come From? by Margaret Sheffield, a treasure that is now, sadly, out of print. In fact, its penultimate page depicts a mother gently birthing her baby, hands resting on the baby’s torso as it emerges into the world, with another woman labeled “nurse” – clearly a midwife! – standing at her side. Perhaps I can trace my love of the midwifery model back to this image imprinting on my mind at a tender age, along with annual recounting of the story of my own birth, which portrayed my parents’ exhilaration tinged with critique of hospital policies in Lincoln, Nebraska, 1977.
In grade school, I drew a crowd enacting labor and delivery with a doll under my shirt on the playground, and claimed that I wanted to be an obstetrician-gynecologist (of course, I’d never heard of a midwife!). By high school, as I became active in the pro-choice movement, my focus had shifted away from the miracle of creating new life and toward the self-determination of individual pregnant women. At the same time, without a blink of awareness, the early images of gentle birth from Sheffield’s book were systematically annihilated and replaced by the synthetic birth scenes of movies and TV.
I can remember my young adult fantasy well: Scene 1: I wake up with contractions and tell my husband it was time to go to the hospital. He bumbles around breathlessly, too excited to think, as I endure contractions. Scene 2: I am lying in bed in the hospital. It is night. There are dim lights coming from the machines by my bed. I am connected to the machines with tubes and wires. I feel no pain, only excitement for what is to come, and relief that I am being taken care of. Tellingly, there was no Scene 3.
As an undergraduate, I encountered midwifery as history; my Introduction to Women’s Studies course was taught by a new Harvard professor named Laurel Thatcher Ulrich, well-known for her chronicle of the life of a midwife in 18th-century America. A renewed appreciation for the midwives who stood up to Pharoah in the biblical book of Exodus was ingrained throughout my independent study of Jewish feminism. Faculty or students may have discussed midwifery or childbirth at some point, but it simply didn’t register. It is still astonishing to me that I could have received a degree in women’s studies from Harvard without encountering academic treatment of the medicalization of childbirth. Two years after graduation, I read a novel called Midwives by Chris Bojalian. Still unaware of the existence of modern-day midwives, I finished the novel sympathetic to midwifery but reconciled to its inevitable demise.
Looking back, I feel a surge of fury. How could I have been so oblivious? How could a young and empowered girl – who, when she wasn’t busy giving birthing demos, was lecturing her peers about why Barbie was bad for girls’ body image – be duped into swallowing the cultural norms portraying birthing women as passive hospital patients? I am sure that I was affected on a deep level by the rhetoric of the reproductive rights movement – by design, downplaying the fetus and the miraculous aspects of pregnancy, distancing women from the "products of conception" and the "contents of the uterus," and emphasizing reliance on medical technology. (In case you are wondering, I still support laws that ensure access to safe abortions, though I believe strongly that abortion is a tragedy and should be used only as a last resort as early as possible in pregnancy.)
I will never know just how it happened, but I think it was as simple as that I had never been formally introduced to midwifery.
The catalyst for my epiphany was a friend, Anne, who had taken a college course on gender that examined the history of birth in America with a critical eye; the sourcebook that she lent me included excerpts from Birth as an American Rite of Passage by Robbie Davis-Floyd. Before I’d had a chance to do any reading, however, Anne told me about a class field trip to a birthing center where she witnessed a water birth. I don’t remember her description of the birth, but it lit a spark within me that caused a spontaneous combustion. For me, learning about the continuing practice of midwifery led me to feel a twin sense of belonging and homecoming.
What is a midwife?
A midwife is an expert in normal pregnancy, birth, postpartum and well-woman gynecological care. Midwives work in hospitals, offices, birthing centers and at home. There are two basic types of midwives: midwives who have additional training as nurses (Certified Nurse-Midwife) and midwives whose scope of training includes only pregnancy and well-woman gynecology (Certified Professional Midwife, Certified Midwife, Licensed Midwife, Direct-Entry Midwife). Midwives work in partnership with physicians when encountering complications outside their scope of practice.
Many countries across the globe rely heavily on midwives in the care of pregnant women, from developing nations where traditional birth attendants must travel on foot to remote villages to Scandanavian countries with universal health care, where the vast majority of women receive prenatal and birth care from midwives, with obstetricians utilized only in case of complications. In the United States, around10% of births are attended by midwives.
The Midwifery Model of Care
Developed in 1996 by representatives of the Midwives Alliance of North America (MANA), the North American Registry of Midwives (NARM), the Midwifery Education Accreditation Council (MEAC) and Citizens for Midwifery, the Midwives Model of Care is based on the fact that pregnancy and birth are normal life processes.
The Midwives Model of Care includes:
- Monitoring the physical, psychological, and social well-being of the mother throughout the childbearing cycle
- Providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support
- Minimizing technological interventions
- Identifying and referring women who require obstetrical attention
The application of this woman-centered model of care has been proven to reduce the incidence of birth injury, trauma, and cesarean section.
Why should I consider finding a provider who uses the midwifery model of care?
- Choosing a midwife – or another provider who uses the midwifery model of care – is one way of empowering ourselves as health care consumers.
- The midwifery model is collaborative and respectful, enabling us to think for and take care of ourselves, while using our provider as a resource. In contrast, the conventional medical model involves a doctor taking care of a passive, compliant patient. For example, midwives often ask that their clients chart their own weight and teach them how to do their own dipstick test for protein in urine. These are basic, easily teachable tasks that every woman can easily perform and then discuss with her provider. The typical routine of having a nurse perform basic tasks reinforces the message that a woman lacks agency and must rely on outside medical help. The midwifery model supports our efforts to be proactive about our own health.
- Our health benefits when we find a provider we can trust and talk with without feeling rushed or intimidated. A midwife is more likely to be in a position to offer this type of relationship.
- Midwives are, by definition, experts in the wide range of what is considered “normal.” Doctors are trained to look for what is abnormal or pathological. A midwife who has a close working relationship with an obstetrician-gynecologist can provide a smooth transition and continuity of care if one of her clients needs medical intervention.
- Providers using the midwifery model possess greater intrinsic trust in birth and women’s bodies. If you are interested in birthing without medications or medical interventions, a midwife will support you and help you reach this goal whenever possible.
- Typically, midwives strive to offer continuous support throughout your labor and birth. Whereas a doctor rarely spends time with a woman during her labor, only arriving in time to “deliver” the baby, a midwife is present continuously, helping a woman cope with labor and assisting with her birth when the time comes.
It is important to realize that these are generalizations. There are many types of midwives and many types of doctors. You might find an ob/gyn in private practice using the midwifery model much more than a certified nurse-midwife who works in shifts at a hospital. It is important to get a sense of how you feel with the provider, rather than focusing solely on their credentials.
For example, I have seen midwifery practices that do not practice the midwifery model to the fullest extent. Their office environment and procedures may be indistinguishable from that of a mainstream ob/gyn. They may work on a shift schedule when seeing patients/clients and for births, which decreases opportunities for one-on-one connection. Some hospitals even have "hospitalist" midwives attending births whom women meet for the first time when they come in during labor.
Learn More about Midwifery Care!
I recommend the following links to learn more about the midwifery model of care:
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