Midwifery: Giving Birth Control back to Women
Midwifery — the traditional practice of having a trained woman, rather than a doctor deliver babies—has actually been practiced for centuries. In fact, having medical doctors, particularly male doctors (since female doctors, until recently, were rare) attend births is a relatively new practice. A midwife is a trained professional who specializes in supporting women during pregnancy and birth by providing one-on-one attention and care, education, counseling and support.
There are two main categories of midwives in the United States: nurse-midwives who are also registered nurses and “direct entry” midwives who are trained in pregnancy care and birthing techniques, but are not nurses.
The philosophy of midwifery is basically that pregnancy and birth are normal life processes, while obstetrics focuses more on the difficulties of pregnancy.
A Pregnant History
It was during the 17th and 18th centuries that the current practice of obstetrics came into being as knowledge and study about human anatomy grew. Labor and delivery methods continued to be more widely practices until nearly 50 percent of all deliveries in many parts of England were attended by male doctors. (Obstetrics and Midwifery) Obstetrics became even more specialized when birthing hospitals started cropping up.
The discovery of ether, morphine, chloroform, and scopolamine as pain-relieving drugs encouraged women to seek male physicians and hospital-based births. Current obstetrical practices were established soon after, such as anesthesia, forceps delivery, enemas, no food or drink for the mother prior to labor, episiotomy, and the reclined position for birth. By the end of the 20th century, cesarean section and induction were part of obstetrical practice. It should be noted though that in comparison to the initial obstetrical practices, today’s methods have been greatly honed and improved in the last 300 years. Forceps are rarely used now, measurement of pain relieving medications is more precisely calculated, and the choice of drugs available has greatly improved the birthing experience — relieving pain while allowing the mother to be fully aware of the experience and reducing neonatal side effects.
It was thought that with the increased rate of knowledge about birth and human anatomy that attendance at birth of doctors would reduce maternal and infant mortality rates. However, it is interesting to learn that mortality rates increased during the upswing in the “obstetrical revolution” between 1900 and 1930. (Obstetrics and midwifery) Maternal mortality rates decreased with the discovery of sulfa-based drugs after 1935, and better antiseptic and hygiene practices, as well as the discovery of treatments for toxemia, safe blood transfusions, and after-birth hemorrhaging.
Holland and Sweden continue to be the world leaders in midwifery. A report published in 1992 found that in 1935, the rate of obstetrical use in Dutch births was 1 percent, while in New York it was 20 percent. In those cases of obstetrical interference, the death rate due to infection was 40 per 10,000 births, while the rate for spontaneous deliveries was 4 per 10,000. (Obstetrics and Midwifery) In Holland, one out of every three births is a home birth. Dutch midwives enjoy greater autonomy and government support than midwives in almost any other industrialized nation. Interestingly, the mortality rate in Holland in 1992 was the “tenth-lowest rate in the world, at 6.3 deaths per thousand births, while the United States ranked twenty-second. Swedish midwives stand out as well, since they administer 80 percent of prenatal care and more than 80 percent of family planning services in Sweden. Midwives in Sweden attend all normal births in public hospitals and Swedish women tend to have fewer interventions in hospitals than American women.” (Obstetrics and Midwifery)
Trending back to Tradition
In the 1940s through the early 1960s, women knew very little about what happened to their bodies during pregnancy and childbirth. There were no “sex ed” classes, and the pregnancy education that midwives used to offer, passed down among generations of women, was either lost or hard to come by. The dependence on the medical practices of the day resulted in heavily sedated mothers and babies, and not allowing fathers in the delivery room. Heavily drugged babies meant the use of forceps to pull them out of the birth canal. Babies were held upside down, spanked on the bottom to make them cry, and immediately whisked away from their mothers and cared for by nurses in “assembly-line” style nurseries. The nurses fed the babies formula and discouraged women from breastfeeding and even administered medications that would dry up the mothers’ milk. (Hanna-Cheruiyot) There was no focus or even interest in mother/baby bonding that happens through skin-to-skin touch immediately after birth or the benefits of breastfeeding.
As women have learned more about their bodies — as have doctors — over the ensuing decades, birthing practices have become a lot more humane and less institutional. Doctors like Leboyer, Odent, Lamaze, Dick-Read, Bradley and others, started advocating conscious relaxation techniques for mothers, for mothers to be awake during birth, and for fathers, and in some cases siblings, being allowed in the delivery room. Delivery rooms ceased to be a surgical affair and became a little more relaxed in the form of personal birthing rooms in many hospitals.
Here and now in the 21st century, midwifery is experiencing a surge back to traditional birthing practices and away from sterile, somewhat impersonal and undignified obstetrics, with the aim to make birth as normal as possible, whether the mother decides on a home birth or decides on or requires a hospital birth. Many more mothers are choosing midwives to provide much more personal and attentive care throughout pregnancy, during birth, and in the first few weeks after birth. Midwives are quickly becoming a welcome option for new mothers, and supported by more and more doctors when their patients request a non-hospital or non-doctor-based delivery.
Darlene Oakley is a freelance writer for EmpowHER.com.
Frequently Asked Questions about Midwives and Midwifery. Citizens for Midwifery. Web. Apr 16, 2012.
Midwifery. World Health Organization. Web. Apr 16, 2012.
“A Brief History of Midwifery” Hanna-Cheruiyot, Cordelia. Wholistic Birth Resource Center of Southern California. Web. Apr 16, 2012.
Obstetrics and Midwifery. Encyclopedia of Children and Childhood in History and Society. Web. Apr 16, 2012.
Am I Ready For Labor? EmpowHER.com
Am I Ready For Labor?- Part 2. EmpowHER.com
What is a Birth Doula? EmpowHER.com