I meet a lot of wannabe midwives, and a lot of midwives. The wannabe midwife I meet most frequently is the one who is angry with the “birth system” and plans to become a midwife to fight that system. Usually, the plan is to become a homebirth midwife to provide for births, “the way they should be.” I like to ask wannabe midwives two questions before I agree that is their path. Why? Because usually they do not realize all the ways to bring change to the system.
Question #1: What is it about the “birth system” that bothers you?
While your first response may be, “everything,” think deeper. Are you concerned about the treatment of women? Are you frustrated with the current protocols? Do you feel research is lacking? Is is restrictive legislation that irks you? It is important to understand what part of the system you feel is broken, and which part you want to fix because the fix for each part is different.
Question #2: How can you have the biggest impact on that part of the “birth system?”
I find wannabe midwives default to the goal of homebirth midwife because it feels like the best way to change what is happening in births. Some wannabe midwives feel it is the ultimate rebellion against a system they dislike. But rebellion can take many forms, and can happen within the system as well as outside the system. Let me share with you a few of my birth heroes who are not midwives to show you what I mean.
Joy Lawn is a pediatrician who was dis-satisfied with the lack of information about neonatal deaths around the world. She fought back with epidemiology by devising systems to estimate the number of deaths and to identify the causes so the public health community could begin to tackle the problem and measure their success.
Barbara Harper is a nurse who uses her skills to help hospitals around the world create safe and gentle birth protocols by collecting and sharing research. She teaches midwives, nurses and physicians the importance of gentle birth and ways they can achieve a gentle birth in their hospital.
Penny Simkin is a physical therapist who uses her understanding of the mechanisms of the physical body to help birth workers improve outcomes through positioning and non-medical interventions when possible. She participates in research to build the knowledge base. Her writings are required reading for many doula and childbirth education programs.
Citizens for Midwifery is a group of parents that advocate for good legislation for midwifery practice. Their work includes collecting and distributing research to local and national legislators while also educating and recruiting other parents to join the work.
EuGene Declercq uses his research skills and knowledge of political science to challenge current beliefs about the American maternity system. His papers point out hidden problems and highlight the importance of midwifery.
I addition to these “big” names, there are many unknown men and women changing the face of birth in the United States and around the world.
I think of the nurses who put in extra hours to participate in quality improvement and protocol committees at their hospitals to succeed in implementing policies prohibiting inductions before 39 weeks.
I think of the peer breastfeeding counselors with WIC programs who are improving breastfeeding success among low income women.
There are many more unknown individuals who need more help to achieve change.
I think of brave souls in insurance companies who are willing to champion the use of doulas, birth centers and homebirth midwives to ensure these services are covered by their programs.
I think of administrators at small hospitals who feel they need to close their birth services due to financial instability, forcing women to travel greater distances when they need care.
There is a great need for change in birth, in the United States and around the world. Where you fit within this change may be practicing as a homebirth midwife, but it might not. We definitely need good midwives. But remember that when you practice as a midwife, you limit the time available to do non-midwifery work and may limit the impact you can have in these other ways. Think of your passions, your skills and what is available around you to determine how to maximize your impact.