Written by Mary Love
When I tell someone I am a midwife, I usually receive one of two responses, “Oh wow, I didn’t know midwives even were a thing anymore” or “Oh wow, we had an amazing experience with a midwife...[insert totally awesome birth story].” Currently, only ten percent of births in the US are attended by midwives, when they could provide 87% of essential care for women and newborns. In the US, midwifery is like a best-kept secret, but it shouldn’t be.
The WHO has named 2020 the “Year of the Nurse and Midwife.”
Across the globe, midwives are front line providers in maternal and infant health. Women who receive midwifery-led care are less likely to need interventions and more likely to be satisfied with their birth experience. Both the World Health Organization (WHO) and the United Nations (UN) cite increasing access to midwifery care as essential in improving maternal and infant health outcomes worldwide. In fact, the WHO has named 2020 the “Year of the Nurse and Midwife.”
Since the fall of the Taliban in 2002, Afghanistan's maternal death rate has dropped by nearly three quarters. Much of this success is credited to increasing access to community midwives. But midwifery doesn't just improve outcomes in underdeveloped nations, positive effects are seen throughout the industrialized world as well. Countries with the lowest maternal and neonatal mortality rates (Sweden, Finland, Iceland, Norway, and Australia, the Netherlands, just to name a few) have the most robust midwifery services. Did you know that in the United Kingdom there are four midwives for every obstetrician and their maternal mortality rate is 2.7 times lower than in the US? Midwifery works here too! A recent study found US states with increased integration and access to midwifery services had better maternal and infant outcomes.
So what makes midwifery care different? The most basic premise of the midwifery model of care, is that childbirth is a normal physiologic process. Having a baby is not an illness or a state of poor health. Pregnancy is not pathology; it is physiology. Like digestion, hair growth, and sleep, reproduction is just another bodily function (albeit an amazing one). Most of the time these processes happen without much thought or intervention. We don't go to the doctor when we need a haircut and thank goodness we don’t need a medical exam every time we poop!
Pregnancy is not pathology; it is physiology.
So if birth is normal, why does a woman need anyone? Yes, childbirth is normal, but it isn't necessarily straightforward, nor is it easy. A good analogy is that it is like a common destination on a map. Although the end is the same, everyone starts in a different place and takes different routes to get there. For some the road is straightforward, fast, and efficient. But for others, the journey is winding, long, and difficult. Midwives are like GPS, a Sherpa, and AAA all-in-one. We can help plan the trip, give directions, provide support, change a tire, and bring you some gas, but we cannot drive the car. Midwives look for problems down the road and search for safe alternative routes, and when needed, we can also call a tow truck or emergency roadside assistance (aka a physician). Midwives are highly trained, skilled clinicians, who vigilantly monitor the health of both mother and baby, and when needed, refer to an obstetrician or other specialists.
Having a baby affects every aspect of a person’s life. It is not just a physical process, it is also a psychological, spiritual, and social process. Midwifery care includes all of this and is woman-centered. The very definition of the word Midwife means “with woman.” We meet women where they are and build a relationship based on trust, respect, informed consent, and self determination. Our care is nurturing and focuses on empowering health and well being. If the whole person is strengthened and supported through the whole process, the risk of complication and the need for intervention is minimized.
“In medical school, we are learning all the things that can go wrong, but nothing about what goes right.”
Not long ago, a medical student working with me made a very astute observation. He said, “In medical school, we are learning all the things that can go wrong, but nothing about what goes right.” BINGO! Physicians are trained to diagnose and treat pathology. Obstetricians must learn how to handle countless medical problems that can coincide with pregnancy, AND, to be excellent surgeons. This is a monumental task! Medical training and practice leaves little time to learn the many nuances of normal uncomplicated birth. And that is OK - that is what midwives are for!
What the rest of the world knows, but we are slow to acknowledge in the US, is that the professions of midwifery and obstetrics don’t compete - they complement one another. Midwifery care is not a frill or luxury. It is not an alternative option, but an essential piece of the puzzle. Obstetricians need midwives just as much as midwives need obstetricians. And women shouldn't have to choose one over the other - they should be given both. Midwifery care shouldn’t be a best-kept secret, it should be the backbone of our maternity system.