Midwife means “with woman.” Traditionally, women have attended and assisted other women during labor and birth. As modern medicine emerged in the West, birth fell into the realm of the medical. Today the medical or technocratic model of birth is the mainstream in America while other countries, who use midwives as the primary care givers for natural pregnancies, use the holistic midwifery model of care.
The World Health Organization acknowledges that midwives should be the primary care giver for women with natural pregnancy or low risk while doctors should care for the high risk (which may includes twins, breeches and other pregnancies that require the facility of a hospital). The table below (adapted from the book, Birth as an American Rite of Passage by Robbie Davis-Floyd; U.C. Press, Los Angeles, 1992)shows differences between the medical and the midwifery model of care.
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Medical – Technocratic |
Midwifery – Holistic |
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Male centered, woman is an object/patient, male body is the norm, classifying and separating approach to care, mind is above and separate from body, female body is a defective machine |
Female centered, woman is a client, the female body is the norm and normal on her own terms, holistic and integrating approach to care, mind and body are one, female body is a healthy organism, and pregnancy and birth are inherently healthy |
Midwives make sure that the woman will have a natural pregnancy through proper prenatals and responsible and conscious mothering. During the 1960s and 1970s, along with the women’s movement and renewed interest in homebirth, the midwifery movement rekindled. It has been growing steadily ever since.
Midwives are becoming more and more involved with birthing families and have been instrumental in redefining birth as a natural event in women’s lives. They offer family and women centered birthsto empower people with the experience of birth.
How to Choose a Midwife
Choose a midwife with whom you feel confident and compatible with your beliefs about birth and your body.The following questions may help the pregnant woman to select a midwife who is well suited to her and her family:
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How did she become a midwife?
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What training has she had? Is she certified or licensed by any organizations?
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What is her basic philosophy of childbirth?
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How many births has she attended as the primary midwife?
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What is the fee for her services, how must it be paid, what does it include?
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What kinds of services are included in prenatal care?
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Does she work with other midwives or assistants at births?
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How do you reach the midwife; does she allow 24 hour access?
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How does she handle problems or complications that might develop during labor?
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What emergency standard equipment does she carry? What herbs or medicine does she use? Which ones does she carry and why? Does she have any affiliation with a physician who can answer unusual questions either during the pregnancy or in an emergency?
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What is her policy for transporting to a hospital?
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What kind of postpartum care does she provide? (frequency of baby check-ups; assistance with nursing)
In addition to asking these questions, it is important to be clear about what you expect from your midwife. Be prepared to share your vision of your birth and discuss any fears that you may have. Determine if the midwife’s answers to your questions agree with your desires. Trust your instincts. You will know when you have found your midwife.
Prenatals
Prenatal visits may take place at the midwife’s home or clinic or at the family’s home. The latter is especially comforting for the family as they are in their own surroundings and may be less hesitant to ask questions and get involved. Prenatal visits are also a time for the midwife to get to know the family and friends, neighbors, or other children who may be present at the birth.
Prenatal care for the pregnant woman includes discussion of nutrition, exercise and overall physical and emotional well-being, as well as overseeing the healthy development of the fetus.Midwives include the family during prenatal care, inviting them to ask questions and to listen to the baby’s heartbeat. Intimate involvement of the family throughout the pregnancy allows for early bonding of the newly emerging family unit.
The midwife and family will often discuss the mechanics of birth. The more people know about what is going to happen, the more comfortable they will be while awaiting the birth. The midwife interviews the pregnant woman to determine if a high risk situation exits (homebirth may not be a viable option for everyone).
Most homebirth midwives screen out a high risk pregnancy (those with certain special needs or medical conditions such as diabetes or blood disorders or carrying twins or a breech baby) to birth only in the hospital. This process is especially important for families in rural areas many miles from a hospital.
During this time the midwife helps the family to prepare for the birth. The family may want to have a birth plan. This includes a list of what will occur during the birth: special music, food and drink, candles, religious or cultural rituals, who will be in attendance, which room in the home will be the birthing room, what kind of support the mom desires, etc. These steps enable the family to create the atmosphere they want.
Continuity of Care
After the baby is born, the midwife doesn’t go away. She is still accessible for information and support. This can be of great comfort during the postpartum period when moms have questions or problems. The midwife will continue to check in on the mother, baby and family for a usual time frame of six weeks, although some midwives will continue to get calls for much longer. Some families and midwives form lasting friendships based on the joy and trust they shared at birth.
Birth is a well designed process, and most women can give birth easily by trusting in themselves and in their midwives or doctors. It is my goal that the mother would travel the path of natural birth, with its fullness and its unknowns, with the help of midwives.
