If you’ve never checked out the BBC show (on Netflix) Call the Midwife, you should. I happen to love period pieces so this was a no brainer for me. The show is based on the memoirs of the same name by Jennifer Worth, a real life midwife, in 1950s London’s East-End. Jenny, as she is referred to, works as a nurse midwife with some of the East Ends’ poorest, showing dedication, passion, and most importantly, attention and care. I realize that it is a tv show and only somewhat true, but the attention that was shown from the midwives to their patients got me think and when I looked into the practice of midwifery I found that while the characters on the show were acting, their portrayals were pretty spot on to how midwives function in Europe. One I started really researching all aspects of midwifery, the more I fell in love with it. From their history to their education and training, their philosophies and evidence-based practice, I knew after only a few hours of research what I wanted to be when I “grew up.”
In The Beginning…
There was the midwife. Midwife, which is the classical latin definition for obstetric, dates as far back as 5000 B.C. and is even referenced in the Old Testament of the bible. I have seen so many people talk about home births with midwives as a new fad, but this method of child birthing is older than Jesus himself (who, ya know, wasn’t birthed in a hospital.)
Up until the late 1800s-early 1900, midwives dealt with all thing pertaining to women’s’ reproductive health. It was simply inappropriate for a man, even a doctor, to deal with a woman “underneath her skirts”. In America, the practice of midwifery came to the colonies the same way the people did – on a boat. The Native Americans also used a midwife-type system to deliver their babies, which was typically done by the oldest women in the village or tribe.
It wasn’t until the late 1800’s that medicine began to be professionalized; and it was done so in the spirit of competition. Doctors soon realized the market of childbirth could be a profitable on, and made a move to push out the midwife, raising concerns that they were untrained, unknowledgeable and unqualified to deliver babies. Ironic though, that in 1920 the Flexner Report was published, stating that the majority (90%!!) of doctors had not received a college education and those that had, had attended substandard medical schools. Furthermore, it stated that Obstetricians were the worst offenders in the undertrained/uneducated categories… hmmmm…
Why Are Midwives So Important?
Like most people (read: ALL people), I like options. If I was stuck wearing the same black jeans, shirt and shoes for the rest of my life that would be so boring and awful (actually, I secretly think it’s wonderful because I have no idea how to dress myself, but for the sake of this argument, it’s “awful“). And that’s why midwives are so important: they offer women an option in an area where there are hardly any options. Midwives break away from the standard hospital setting and offer women a say in their births. It is becoming more and more common today for women to have their wants and preferences deliberately ignored in the delivery room. i personally have friends that have dealt with these experiences, having been told by their doctor, “I’m going to do this whether you like it or not, so can you please be quiet now?” during a scenario that was nowhere near emergent.
Prior to the 1950s rise of the midwife, childbirth was seen as a medical condition, not a normal female experience. In 1915, Dr. Joseph DeLee, author of the most important obstetric textbook of that period, described childbirth as a pathologic process that damages both mothers and babies “often and much.” He said that if birth were properly viewed as a destructive pathology rather than as a normal function, “the midwife would be impossible even of mention.” To save women from the “evils natural to labor.” he proposed interventions which included routine use of sedatives, ether, episiotomies, and forceps. Dr. DeLees views are still in practice today, over 100 years later. This right here is why midwives are so important. Typically, midwives are heavily focused on low interventions during birth. The less interference during delivery, the easier on both babies and mothers. In 1952 The Midwifery Section of the National Organization for Public Health Nursing developed a philosophy that emphasized pregnancy and childbearing as a normal process, as well as a family-centered event. This is the philosophy we as, not only a country but a civilization, should be focused on achieving world-wide. Childbirth is such a beautiful miracle, it should be celebrated in a way that fits the family and not rushed along on whatever schedule best fits the doctor and/or hospital.
But Are Midwives Qualified?
Absolutely. They wouldn’t be allowed to practice in hospitals, clinics or hold their own private practices otherwise. There are 2 types of midwives: Certified Nurse-Midwives and Direct Entry Midwives. A CNM is a graduate degree and they are licensed in all 50 states. In all but 7 states, CNMs are able to practice without the supervision of a doctor. The other type of midwives are DEMs. DEMs enter midwifery school without any higher education, similar to a trade school. These midwives are far less popular than CNMs and are only licensed to practice in twenty-seven states and are heavily supervised in most of them. Either way, both types of midwives are thoroughly trained and most pass rigorous exams to obtain their license. In California, licensing is through the Medical Board of California.
Understanding the potential danger in the overuse of childbirth technology, the World Health Organization has repeatedly implored the U.S. medical authorities to return to a midwife-based system of maternity care as one way to help reduce our scandalously high mortality rates.
The United Stated has the highest mortality rates of any developed country. The safest countries for the birth, the USA is 50th/184 countries for babies and 46th/184 countries for women. The number of European countries ranked higher in mortality than the United States: 0. In fact, the US is one of few countries where mortality rate have risen since 1990, another country with this sat: North Korea.
If anyone has their midwife game down, its Europeans. The percentage of European births attended by midwives is reported to be somewhere between 70-75%. While in the USA, out percentage of midwife-attended births is 4%. These numbers seem to correlate directly to our high infant and maternal mortality rates and Europe’s low mortality rates.
A study done in Texas looked at infant mortality numbers between doctors and midwives and found per 1000 lives births, direct entry midwives experienced 1.9 deaths, doctors experienced 5.7 deaths and certified nurse-midwives experienced just 1 death. Now this doesn’t exactly mean midwives are any better, as midwives are not qualified to handle the high-risk cases that doctors are, but it certainly should be considered.
Anyone having a baby should definitely look into using a midwife. The option may not be right for all, but the personal attention, family-centeredness and quality training of a midwife should not go unexplored. I’m not even into nursing school yet, but I’m still eagerly plotting my plan once I graduate so my path to becoming a certified nurse-midwife can be that much closer.