I think it is pretty safe to say that midwifery is one of the first DIY skills in human existence. Certainly, the human body knows instinctively what to do when the time comes to birth a child. Still, I can’t imagine that we would have gotten very far as a species without someone learning how to assist in childbirth, give guidance to a mother, provide assistance to a newborn, and generally know how to take care of business.
It appears that learning the art of midwifery is flourishing both in the US and abroad. A recent story on public radio discussed how clinically trained midwives in rural Mexico might be a real healthcare solution for mothers living in rural areas, far from hospital care. Officials are hoping that by training professional midwives in basic nursing, gynecology, and obstetrics, they can not only help mothers without access to healthcare, but ease the burden placed upon the country’s overwhelmed hospitals. Worldwide health organizations have the same hope for other countries where physicians are scarce or far from rural communities.
According to the World Health Organization, approximately 350,000 women die every year due to pregnancy and childbirth related complications. Most of these preventable deaths occur in poor, rural, low income regions. They maintain that trained midwives could reduce the risk of both mother and child death during birth. About 1000 women and almost 10,000 newborns die every day due to largely preventable complications that could have been attended to by a skilled midwife. However, more than one-third of all births in the world take place without a midwife or trained health staff member.
For many expectant mothers in the United States, choosing a midwife can mean an embrace of a more natural way of life and a separation from the clinical aspects of childbirth. Some choose midwives to assist in their delivery in order to allow a more personal birth experience. Most hospitals allow midwife assistance as long as a doctor is available if intervention is needed. However, here in the U.S., more and more women are seeking home birth experiences. Often, this experience, when attended only by a midwife, is illegal in the United States – though this varies from state-to-state. Doctors and midwives continue to debate the safety of births assisted only by midwives, especially home births.
Still, stereotypes about midwives are fading. A study done by the US Centers for Disease Control found that one in every eight births in the U.S. was assisted by a midwife. Today, there are more than 5,000 certified nurse midwives in the United States who attend approximately 150,000 births annually, primarily in hospitals. Just about an hour north of our office here in Florence is a midwifery center known as The Farm that was founded by one of the most renowned midwives in the world, Ina May Gaskin. (Gaskin wrote the imperative tome Spiritual Midwifery.) This center has been open for over 40 years and the trained midwives there provide pre-natal care, assistance with delivery, and post-natal care. The center also holds training workshops to educate the next generation of midwives.
In a sense, having a child has – for a woman – always been a DIY experience. But, as trained midwives continue to find a place and fill a need for women, particularly in developing nations, we may be slowly taking more responsibility for our own health. There will always be instances when intervention via physician or hospital is absolutely necessary. But, midwives are an important option for women across the globe. Some women have the luxury of choosing to deliver using a midwife. For others, having a midwife can be the difference between life and death. The women who are studying to be clinical midwives in Mexico and some developing nations are solutions to a critical health problem. Women choosing to care for other women all over the world – re-learning and reinforcing “living arts”, educating, and empowering themselves: real women, indeed.
Images are from Spiritual Midwifery, The Family of Woman, and Edward Steichen’s The Family of Man.
Spiritual Midwifery was one of my “formation” books and I have always read everything I could about Ina May and The Farm (http://www.thefarm.org/midwives/index.html). Thanks, Natalie, for featuring the first, and most important, profession.
It’s very interesting to know how it works in other countries: here in France, if a pregnancy goes without trouble and the baby is presenting in a good position then no doctor is called – the midwife will be the “default” person leading the delivery. It might also depend on the training of said midwifes (quite intensive 4 years in France, with the first year in common with medical students); I know for example that midwifes in nearby Belgium don’t have the same role: they’re more of a nurse specialized in pregnant women and babies..
Great to see someone talking ( blogging) about such an important issue. We have become rather complacent in the West about our access to professional help with birth. I lived for a couple of years in Nepal where a very tiny percentage of births are attended by any trained professionals with a resulting terrible impact on women’s lives. In one district,where there is no hospital, the life expectancy of women ( mainly due to pregnancy related complications) is 34 years – and this in the 21st century ! The solution is , as you say, training midwives to attend births not building expensive hospitals.
Here in the States, we’ve had 6 babies born at home (4 under water!) with the assistance of wonderful, amazing midwives! Two pulmonary embolisms meant baby #7 was born at a hospital via induction. 🙁 Grateful to be alive but the whole experience was so hard compared to the kind of care we had had before with midwives! We are planning another hospital birth with baby #8 but are working with a nurse midwife & hope to use water.
So, yay for midwives! 🙂
I have had both types of birth. The first was in a hospital with a doctor. It was drug free, but not the experience I wanted. I had hoped for more. With baby two, I found a mid wife and had a home water birth. It was incredible. I am very thankful for my home birth. I was (am) a healthy person, so it was an ideal situation. I think if more people approached child birth as a non medical event, there would be less interventions, and potentially easier births. That said, I too know there is a place for doctors and deliveries. I can’t believe there are so many maternal and baby deaths. That makes me very sad. Unbelievable in this day and age. Thanks for the post.
Great post! Thank you for helping to dispell the stereotypes and myths around midwives. My daughter was born at home with a midwife fifteen years ago, and the support and care I received during the most important event of my life has influenced my parenting for all these years.
Beautifully written! Thank you for featuring this on your blog. It’s especially dear to my heart, as my husband and I prepare for starting a family. I pray that by the time we start having babies that we can have a midwife-assisted birth in AL.
I think the issue is complicated. I read Spiritual Midwifery while a PA student in 1991 and fell under it’s spell. I really felt called to doing obstetrics. Yet, when I did an OB rotation with a group of nurse midwives I was disappointed. They gave lip service to a more wholistic approach but frankly were neither particularly kind nor competent. Because I was on the PA track they also weren’t that interested in fostering my ambitions. Doctors are not the only ones who can be jealous of their turf. Both of my daughters were delivered by male OB’s in hospital, the first in 1984 and the second in 2002. Both good experiences in which my wishes were respected to the extent possible. The first birth with no intervention and the second induced and with an epidural – much more than I wanted but appropriate under the circumstances.
That said, I think that skilled but minimal intervention makes much more sense in both the developed and developing world. The thing I find most frightening is that in the 18 years between births, women have become less confident in their ability to give birth without epidurals etc. Hospital based childbirth education programs are created to make women afraid of the experience. My sisters and sister in law sadly have had really negative experiences either with their birth process or the breast-feeding experience or both (the latter often due to misguided, rigid advice from so called lactation consultants).
I think the solution is that if you have the option to chose your provider, do so carefully AND find independent sources of information for childbirth education and aftercare whether that be a doula, a non-hospital based program, and/or La Leche League. And remember, it’s not whether you have the perfect birth experience that counts in the end. It’s whether mother and child come out safely on the other end.
What a lovely post on midwifery. I am especially happy you looked at midwifery and family health from an international perspective. With the proliferation of small grass roots projects many women and their families are experiencing better outcomes. Central to many of these small projects are women’s groups, including community led craft enterprises. By supporting women’s empowerment through access to education and sustainable economic growth we can all, as international citizens, enjoy the benefits of healthy children.
Ina May Gaskin has been a heroine of mine for many years. A new documentary, Birth Story, is being screened throughout the country and I highly recommend it. It tells the story of The Farm and focuses on the evolution of midwifery. The movie is lovely and inspiring.
Thanks again Natalie. Warmly, Jenn
Oh such a complex topic, one so full of life and wonder and risk and of strongly rooted tradition and mindsets. I am a professional midwife and I had the lovely pleasure of working with traditional comadronas (midwives) in Guatemala to bring them updated skills and methods. The wisdom of birth women (midwives) is old and deep. I learned much from them as they did from me. There is so much more to the story though, of how to bring greater safety to the thousands of women and newborns at risk, water, a bar of soap, a clean surface for delivery. Oh ye women of the USA, count the blessings you have. You can choose from various options all of them pleasant enough, you are sheltered close to skilled care when needed. Your house is clean and warm. Choose bravely and wisely and pray for those who have no options. They are indeed the strong;.