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What is a Midwife? Part Three

Aug 27th, 2010 Paths

We have looked at the accepted definition of a midwife, and we have looked at the philosophy that rejects that definition.  I want to finish this series by introducing you to the way I will be using the term midwife on this blog.  The concept has been born in me through conversations with many women I respect who have challenged my preconceived notions and helped me find my own voice. It is an idea that is still evolving in my mind, but formed enough to share.

The root of the word midwife, According to Judith Pence Rooks in Midwifery & Childbirth in America, dates to 1303 and means literally “with wife.”  The term simply meant “a woman who assists other women while they are giving birth” (Rooks, 1997).  She goes on to explain that women supported each other and educated each other as a normal course of events.  The women who became midwives were just really good at attending birth and often sought for assistance.

But what if, in our modern culture, defining the midwife as the baby catcher is too narrow?  Even the international accepted definition recognizes the role of the midwife in educating the woman and assisting her in maintaining a normal healthy state during pregnancy. To what extent this was or was not done by the “midwives” in various parts of the world throughout history I’m afraid I cannot say.  But as to the need in the place and time I occupy, I know it is real.

So what if instead of thinking of the midwife as the one who catches the baby, what if we think of the midwife as one who comes alongside an expectant mother and assists her during this time of transition. Rather than being defined by one instant in time, midwifery is defined as a continuum of services provided to help the family transition successfully.  On this continuum would be the fertility educators, the nurses, the childbirth educators, the doulas, the lactation consultants, the prenatal exercise and nutrition specialists, and the baby-catchers.

I know there are many problems with this definition, most of them legal. But I think it is important to understand and accept how all these interactions work together to bring the woman through the transition to motherhood. Perhaps you are a midwife because you are with the woman as she travels through this transition, this year long transition to being a mother, whether you are at the birth or not. Perhaps “midwife” is as much a verb as it is a noun.  Or, perhaps I need to reconsider this philosophy completely.

You are not a nurse because you give shots.

I like the continuum idea, and I like the “midwife” as a verb idea. But do I really think anyone who works with an expectant family is a midwife?  I don’t know yet.  I’m still trying to sort the fine details out in my head.  I do think words are used because they have meaning, and the words are only useful when everyone understands the word to mean the same thing.  So I can accept the insistence that the term “midwife” only be used by those who fit a specific definition. I can also accept that even though they are related, there is a big difference between a doula and a midwife.  Doulas are great, I happen to be a doula. I have fulfilled the roll of doula at many labors.  But I have not yet fulfilled the role of the “midwife.”  At no time did I accept responsibility for the care of the family. That acceptance of responsibility is a big step. And while I may happen to have much knowledge about birth and could probably perform the function of “catching” the baby, I know developing the acceptance of responsibility takes time. In nursing school, I could perform the function of giving a shot long before I understood all the reasons why I was giving a particular shot.  Being a midwife, and being a nurse, is not really about giving the shots or catching the baby. I remember my very first nursing class the instructor told us, “You are not becoming a nurse so you can give a shot.  I could train a monkey to give a shot. Giving a shot is just something you may do while you do the real work of nursing.”  So I can understand any disagreement with the idea of midwifery as any act of working with expectant families.

But at the same time I accept that a woman is more than a uterus.  There are more changes that happen during this transition than simply the opening of a cervix, and there are more needs than simply massaging the perineum. When you follow the midwifery model of care you ensure all the mother’s needs are met.  She receives education and counseling and support and referrals to others who can help fulfill these needs.  Are these needs any less important to the mother preparing for birth than the catching of the baby?  Is fulfilling these needs not fulfilling part of the midwifery role?

And so this is where I stand today. I did tell you the idea was still evolving right?  Today I see midwifery as a continuum, and within that continuum are many care providers offering many services to help ensure safe birth for all mothers. And though their title may not be midwife, they are all fulfilling the midwifery role.

What This Means to You

You do not have to accept my philosophy or my definition, I promise it will not hurt my feelings.  But please consider it honestly.  Maybe this is the way you have always thought about maternal health and I have simply given voice to your own intuitive knowledge.  Maybe I have challenged you to place more value on the work of others and yourself.  It’s possible you disagree completely.

But maybe, just maybe, I have given you permission to follow your calling to midwifery without your ever having to become a baby-catcher, and that freedom makes pursuing your calling possible.

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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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