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What is a Midwife? Part Two

Aug 26th, 2010 Paths

If you did your homework yesterday, you now know what laws regulate midwifery where you live or where you hope to practice as a midwife. You may have discovered it is not as difficult as you anticipated, or you may have discovered becoming a midwife will take you more years than you wish to devote to the schooling.  So today I want to look at another definition of a midwife from another perspective, a perspective shared in this article from Midwifery Today.

traditional birth attendant

Traditional Birth Attendant or Midwife?

From this perspective, the midwife is the woman who takes care of pregnant mothers.  The type of education she has is not as important as the work she does.  Do you remember from yesterday’s post that the tasks of the midwife were vaguely defined but the process by which to become a midwife was strongly defined?  In the ICM definition, you are midwife because you have completed a government recognized program (and work with expectant mothers in some capacity). But this definition is different.  This definition doesn’t care how you were trained, where you were trained or who approved of your training.  In this definition, you are a midwife because you assume the role of the midwife.

And here is where it gets a little soggy. Is a woman any less of a midwife because technically, for research and statistical purposes, she is a traditional birth attendant?  Is the work she does any less important than the work of a skilled birth attendant (government approved midwife, nurse or doctor)?

And here is where it gets downright muddy.  Should a traditional midwife be required to stop practicing when there are no workable options for care in her community?  If her community is more than a day’s walk to the  closest hospital and families have no access to motorized transportation?  If the women in her community will not accept government approved care because it does not fit within their culture?

Wait, do you think I am only talking about developing countries?  I definitely agree these are problems facing some of the poorest countries in the world, but I also know these are problems families face right here in my own country.

The United States is an immigrant nation.  Families who live within its borders come from all cultures, some who value western medicine and some who do not. How do you provide adequate prenatal care to a woman who sees no value in visiting the doctor when pregnant? What about the family who do not trust western medicine, and so avoid participating in the system? Similarly, much of the United States is rural.  The rural poor are always worse off than the urban poor whether they are in a developed nation or a developing nation.  So what do you do with the rural poor family who cannot use public transportation to visit a clinic?

These may not be the kind of problems you normally think about, but they are very real problems that face every government. Ensuring access to health care means so much more than how much money is available.  It means providing acceptable services to all members of society in a way that meets their needs.

Enter the push for traditional midwifery in the United States.  Seen by some as a move backwards, and see by others as the ultimate in family-centered care. With a wide range of educational experiences, these women define themselves as midwives by the job they do. Every state has them, though not every state recognizes them as midwives.

What Does this Mean to You?

Some women choose not to accept the international definition of the midwife, and instead simply serve the women in their community. These women feel it is more important to serve families than to worry about what the government wants them to do.  Many work as activists to help change government policies. But operating without benefit of  law can be difficult. Spend some time exploring the different ways midwives operate outside the system, and try to change the system.  Check out the Association of Radical Midwives, this article from Midwifery Today and  this brief from Midwives Alliance of North America.

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Jennifer Vanderlaan CNM MPH is the author of the BirthingNaturally.net website. She has been working with expectant families since 2000, training doulas, childbirth educators, and midwives. She has worked with midwives in Central America and Sub-Saharan Africa. Her interest in public health grew in 2010, and she is now a PhD student learning to become a producer of knowledge.

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