What is a Midwife?

From the very beginning women have helped one another give birth. It is the midwife, not the physician, who has attended birth for most of human existence. In modern-day cultures of countries such as Denmark, Holland, and Sweden, midwife-assisted birth remains the norm. In fact, the countries with the lowest perinatal mortality rates in the world all make generous use of midwives, who attend 70 percent of all births. In the United States, where midwives assist only 5 percent of births due to political constraints, perinatal mortality is alarmingly high. Did you know? The United States is the only country in the world where having a baby is considered to be a medical problem. According to census records, there are 42 other countries where it is safer to have a baby. “Every single country in the European region with perinatal and infant mortality rates lower than the U.S. ‘ uses midwives as the principal and only birth attendant for at least 70% of all births.” - WHO Only 3.4% of births in the U.S. are attended by midwives.
(Statistical information taken from the cia.gov factbook publications.)

Midwifery is alive in our society today for one reason only, and that is women’s insistence on midwifery care. Midwifery is simply a fact of life, perpetuated by the needs and desires of birthing women and their supporters.

In order to address the worldwide struggle of midwives to meet their communities’ needs and take their rightful place in the healthcare system, the International Confederation of Midwives (ICM) drafted the International Definition of a Midwife, which was adopted in 1972 by both the World Health Organization (WHO) and International Federation of Gynecologists and Obstetricians (FIGO):

“A midwife is a person who, having been regularly admitted to a midwifery educational program, duly recognized in the country in which it is located, has successfully completed the prescribed course of studies in midwifery and has acquired the requisite qualifications to be registered and/or legally licensed to practice midwifery. "

The sphere of practice:

She must be able to give the necessary supervision, care and advice to women during pregnancy, labor and postpartum period, to conduct deliveries on her own responsibility and to care for the newborn and the infant. This care includes preventive measures, the detection of abnormal conditions in mother and child, the procurement of medical assistance and the execution of emergency measures in the absence of medical help.

She has an important task in health counseling and education, not only for the women, but also within the family and the community. The work should involve antenatal education and preparation for parenthood and extends to certain areas of gynecology, family planning and child care.
She may practice in hospitals, clinics, health units, domiciliary conditions or in any other service.”

Considering the troubled past of midwifery and challenging present of midwifery, we can hardly help but pose the question: What makes midwifery such a deeply desired birthing option? Simply put, midwifery promotes well-being. It is an art of service, in that the midwife recognizes, responds to, and cooperates with nature. Above all, true midwifery care is personalized care. Despite parameters of safety the midwife must uphold, she knows what is “normal” and easily recognizes any behavior that deviates from normal. Her task is to decipher the unique and ever-changing patterns of her client’s well-being. The more thorough and continuous her care, the more likely she is to detect a complication at its inception. She and her client are a team, but responsibility rests with the expectant mother, who is at the helm of her healthcare experience.

Every birth has potential for complications, but with continuity of care, the midwife’s competence in handling these is facilitated both by foreknowledge of the mother’s condition and by the mother’s trust in her abilities.

The essence of midwifery is staying in the moment, being humble, and paying attention. Standardized, fear-based care has never appealed to women. What we really want is competent, sensitive attention to our entire condition. No wonder most women who choose care with a midwife also choose to give birth at home. They instinctively seek the comfort, privacy, and opportunity for family participation found in their own environment, as well as the decreased likelihood of interventions. Research has repeatedly shown that the more relaxed and at ease a laboring womn feels, the more efficiently her body will function. If she becomes stressed or frightened, she will release hormones (catecholamines) which inhibit cervical dilation. In fact, research shows that whenever a birthing mammal is moved, threatened, denied privacy, or otherwise disturbed in labor, an arrest of progress will occur. The midwife’s most basic responsibility to her clients is to do everything she can to promote their relaxation and peace of mind. Her hands are her most precious tools. She is infinitely patient - she waits, and waits, and waits some more. Yet she is ever attentive to the mother’s condition, the baby’s needs. Quietly aware, she serves as a mirror, and offers suggestions in timely fashion. She continually strives to reserve judgement, but is willing to speak the truth as the need arises. Above all else, she keeps the following in mind: “It’s not my birth.” But, simply put, miracles happen in childbirth.

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