Introduction to Midwifery

From: cnmpat@aol.com(Pat Sonnenstuhl)
Newsgroups: sci.med.midwifery,sci.med.nursing,
        misc.kids.pregnancy,misc.answers,sci.answers,
        news.answers
Followup-To: sci.med.midwifery
Approved: news-answers-request@mit.edu
Subject: Midwifery:Introduction
Summary:  This posting is an introductory posting about
        midwifery worldwide for sci.med.midwifery.  Additional
        postings will describe midwifery in specific
        geographical areas.

Archive-name: medicine/midwifery/intro
Posting-Frequency: monthly
Version: 0.01
Last Modified: 1995/10/6

WHAT IS MIDWIFERY?
WHAT DO MIDWIVES DO?
HOW DO I BECOME A MIDWIFE?
WHERE DO I FIND A MIDWIFE?
IS MIDWIFERY CARE SAFE?

1. WHAT IS MIDWIFERY?

The simplest definition of midwifery is "with woman", but truly, midwifery means different things to different people. For many, the Midwifery Model is an attitude about women and how pregnancy and birth occur, and view that pregnancy and birth are normal events until proven otherwise. It is an attitude of giving and sharing information, of empowerment, and of respecting the right of a woman and her family to determine their own care.

The attitude of midwifery, or the Midwifery Model can be contrasted with the Medical Model. In general, the Medical Model is an attitude that there is potential pathology in any given situation, and that medicine can assist to improve the situation. Medicine is also about teaching , informing, and prevention, but the power seems to be more with the provider rather than with the woman.

Historically, midwives have always been around to help women give birth. Before physicians, midwives were the primary healers in their communities. They were the medicine women of their own cultures, and assisted families and women throughout their lives. In the Old Testament they were described as examples of the strength and faith in God. Midwives were once the nutritionists, herbalists, doctors, ministers, counselors all rolled into one 'profession'. Many feel they were the first holistic practitioners. Midwives were always available to help the poor, the women without medical care or the women who were the outcasts of their culture. Today, midwives take care of anyone who wishes to see them, but practice within the constraints of their medical and legal systems.

Today midwives are as diverse as the populations they serve. Midwives are willing to take care of anyone who wishes to see them. Over 70% of births in the world are attended by midwives. In the Netherlands, midwives deliver a majority of the babies. Other countries do not utilize midwives to their fullest potential. Each country worldwide has a slightly different view of midwifery, and of how midwives work within their communities. In sci.med.midwifery, midwives will speak from these various perspectives and cultures. Midwives are encouraged to share their statistics and work situations within this newsgroup.

The World Health Organization (WHO) presents us with the following definition of the midwife:

A midwife is a person who, having been regularly admitted to a midwifery educational programme, 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 practise midwifery.
(WHO, FIGO, ICM Statement)

2. WHAT DO MIDWIVES DO?

Midwives teach, educate and empower women to take control of their own health care. In most communities, they provide prenatal care, or supervision of the pregnancy, and then assist the mother to give birth. They manage the birth, and guard the woman and her newborn in the postpartum period. Most midwives encourage and monitor women throughout their labor with techniques to improve the labor and birth. Reassurance, positive imaging and suggestions to change positions and walk helps labors progress.

Many midwives provide family planning services and routine women's health examinations such as pap smears and physical examinations. They teach women about sexually transmitted infections, and focus on prevention of the spread of infections. What specifically midwives do will depend upon: her training, her licensure, and what is allowed in the state, province, or country in which she practices. For example, in the United States some midwives can prescribe medications, provide women's health care throughout the menopause years. Midwives worldwide attend births in the home, hospital or birthing center, depending upon their education and licensure, and the rules governing their practice. Midwives believe it is especially important to provide time for questions, teaching, and time to listen to the concerns and needs of the women they care for.

The WHO definition of the midwife gives us the following information:

She must be able to give the necessary supervision, care and advice to women during pregnancy, labour and the postpartum period, to conduct deliveries on her own responsibility and to care for the newborn and the infant. This care includes preventative 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 woman, 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 of in any other service. (WHO, FIGO, ICM Statement).

3. HOW DO I BECOME A MIDWIFE?

There are many different paths to becoming a midwife. Which path you choose will depend on many factors: where you live, what the rules and regulations are in your state or country which govern midwives, your age and education, and what sorts of experiences you have had with birthing. The most important thing is that you need to look at your reasons for wanting to become a midwife are, both short term and long term. This will help you determine which path is best for you. The resource published by Midwifery Today Getting an Education: Paths to Becoming a Midwife gives good guidance and information about the various paths to becoming a midwife. In some areas women start as childbirth educators and/or doulas to become exposed to birth and working with pregnant women.

4. WHERE DO I FIND A MIDWIFE?

Seek midwives in your community, state and country of province. Speak with local childbirth educators about midwives they know, and of course, talk with your friends about their birth experiences and their particular choice of provider. Watch for health fairs in your area, check with herb and health food stores and ask questions of other types of health providers such as massage therapists.

Sometimes a call to the local hospital or health center will give you information about midwives, childbirth educators and doulas. Some systems have referral systems for midwives in place, and you can easily locate a midwife. In other areas you may need to ask lots of questions. Locate your La Leche League or other groups that work with mothers and infants, and ask for names of midwives they know. There might be a listing within your phone book for midwives, but some midwives are not listed there due to finances or legalities. For example, in the US, sometimes only CNMs are found in the yellow pages and it might be more difficult to find the names of midwives who attend homebirths. Contact nurse practitioners in your area, your local Health Department and Planned Parenthood. They will usually tell you their favorite providers first

5. IS MIDWIFERY CARE SAFE?

A Guide to Effective Care in Pregnancy and Childbirth is a collaborative effort to prepare, maintain and disseminate reviews of randomized trials of health care using the Cochrane Database. This is an international effort, and a very readable resource. The Database is based on a decade- long study of controlled trials in obstetric care concerning different aspects of care and treatment. It also describes the approaches and decisions that have been demonstrated effective and those for which the evidence in inconclusive or negative. "As technical advances became more complex, care has come to be increasingly controlled by, if not carried out by, specialist obstetricians. The benefits of this trend can be seriously challenged. Direct comparisons of care given by a qualified midwife with medical back-up with medical or shared care show that midwifery care was associated with a reduction in a range of adverse psycho- social outcomes in pregnancy, and with reductions in the use of acceleration of labor, regional analgesia/anesthesia, operative vaginal delivery, and episiotomy. (p 15, ) . BIRTH: Issues in Perinatal Care Vol:22, No 2: June 1995 summarizes this resource.

A second excellent resource is Obstetric Myths Versus Research Realities. This lists many recent abstracts from medical research in an organized and systematic fashion. It would be impossible to quote them, and one needs to review this text to appreciate its value.

Women seeking assistance for her pregnancy and birth will find providers at all points along the spectrum: physicians that are highly interventive, physicians that behave similarly to midwives that are non-interventive, trusting herbs and other modalities, and midwives that practice like physicians. The onus is on the woman and her family to question the available providers and find the match that best suits her individual needs.

Please also see the following additional documents describing midwifery in specific areas:

BIBLIOGRAPHY OF BOOKS AND RESOURCES
ABOUT THE PROFESSION OF MIDWIFERY
MIDWIFERY IN AUSTRALIA (not an official FAQ)
MIDWIFERY IN ENGLAND (in development)
MIDWIFERY IN FLANDERS (in development)
MIDWIFERY IN THE UNITED STATES

This FAQ was prepared by Pat Sonnenstuhl, ARNP, CNM cnmpat@aol.com with the supportive assistance and contributions of the following individuals. Suggestions for topics to add to the FAQ are always welcome.

Ms. Sabrina Cuddy < swnymph@abekas.com > :
Childbirth educator, Nursing Mother's Council volunteer, USA
Ms. Elizabeth Couch < kindredspirit@shop.medchem.purdue.edu > : DEM, USA.
Ms. Marjorie A. Dacko < WVUY22@prodigy.com > :
DEM, birthcenter practice, USA
Ms. Sharon K. Evans < BirthRite@aol.com>:
writer and licensed DEM, birth center practice.
Co-chair for the NARM Qualified Evalator Committee
Ms. Cheri Van Hoover < CheriVH@aol.com > :
CNM, hospital practice, USA.
Mr. Patrick Hublou < phublou@innet.be > : Midwife, Flanders, Belgium
Ms. Deirdre E.E.A. Joukas < 065620@pc-lab.fbk.eur.nl > :
Consumers-viewpoint, The Netherlands
Ms. Debbie Pulley < ManaMW@aol.com > :
MANA Legislative Chair CPM, homebirth practice, USA

This FAQ may be reproduced freely for non-commercial purposes as long as the author also received a copy of the posting and the reactions to the posting that the distribution may cause.

This FAQ may be distributed for financial gain only with the expressed permission from the author.

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This Web version was last updated May 14, 1996 by Donna Dolezal Zelzer, djz@efn.org