Keeping the Midwifery Legacy Alive
by Nell Tharpe

[Editor's note: This article first appeared in Midwifery Today Issue 89, Spring 2009.]

Midwifery. The word brings to mind a pregnant woman in a softly lit room, laboring with intent, touched and tended by gentle women who are experienced and wise in the ways of labor and birth. One role of midwives is to protect the sanctity of birth and to honor and cherish women both as they strive to bring forth new life and throughout their lives.

Historically, the word “midwife” has been translated to mean “with woman,” implying a trusted presence and compassionate caring as rock-solid and immutable as the force of labor. In more recent times, the phrase “with woman” has been expanded to mean caring for women across the lifespan; many midwives now have clinical expertise in and offer a wide array of women‘s health services such as family planning, well woman reproductive health care, care of reproductive health problems, and primary care services.

An alternate way of interpreting the phrase “with woman” is not simply being present and providing service to women, but validating women‘s experience of being female and creating environments where women are empowered to find their own voices. The compassionate care of women is the byproduct of a culture of respect, not only of women, but also of the mystery and miracle of fertility and procreation.

Homebirth midwifery in North America functions as the primary paradigm that retains and honors traditional midwifery practices. Homebirth midwifery embodies the core values of midwifery, while providing alternatives to those families who eschew modern hospital-based obstetric and midwifery practice, and keeping traditional midwifery practices alive. Yet nearly 99% of American women choose to give birth in the hospital setting, where many traditional midwifery values and practices are essentially invisible, if they exist at all.

The education and practice of modern obstetrics is touted as “evidenced-based,” although recent Cochrane reviews demonstrated that there is no consensus on what constitutes best practice for labor and birth, or even for surgical delivery. Even in the presence of clear reproducible evidence validating the greater safety of mother-directed, participatory, spontaneous vaginal birth over assisted birth or cesarean delivery, primary and repeat cesarean rates continue to climb. Participation of midwives in maternity care has been demonstrated in numerous studies to decrease the likelihood that an individual woman will give birth surgically.

Our efforts must lead to a greater mainstream acceptance and recognition of the value of midwives in North America. For midwives and midwifery to have a pervasive and effective presence in the future, we must strategically plan for that future today, accepting and working with the rapidly changing technically oriented sociocultural fabric of the 21st century. While a vision of what midwifery is and can be is essential for planning for the future, in order to honor women this vision must support women in all of the locations in which they choose to obtain care.

Regardless of the locations where midwives practice, for traditional midwifery attitudes and practices to endure within our rapid-paced technological society, midwives need to be viewed as leaders in our communities—visible, respected, dynamically active members of the communities in which we live and practice. We are not required to be civic leaders, but to live our beliefs through sociocultural leadership, effectively teaching and modeling respectful attitudes and behavior.

One way to reaffirm and safeguard traditional midwifery practice is through grassroots efforts to replace denigration or trivialization of women, childbearing and issues related to fertility with an attitude of respect that honors both genders. Often in an effort to live our love of pregnancy, labor and birth, we approach midwifery exclusively as the care of adult women. Yet, by the time a child has reached puberty, attitudes and values surrounding male and female roles are firmly established.

Outreach programs are needed to shape future generations of women as resilient, dynamic, self-reliant and autonomous individuals who are capable of expressing their needs and opinions with confidence and who have the ability to access resources to care for themselves, as well as their loved ones. Outreach programs that would benefit from midwifery involvement include family life education programs, adolescent fertility awareness education, participation in domestic violence prevention, and many other programs for women and youth.

Professional opportunities for fostering change abound through participation of midwives in state or local health policy development, on hospital and school boards, in community development and enrichment programs, as volunteers for local organizations, in creating and presenting continuing education programs for labor and delivery nurses, and in physician education related to normal childbearing.

Attitudes of health care professionals are not dependent on the presence or absence of illness, disease or physiologic processes; rather, they are the lived experience of the individuals‘ beliefs about health and illness, their perceived value of people as individuals, and a meaningful expression of their personal and professional integrity. The attitudes of health professionals are affected by the individuals‘ backgrounds, apparent or hidden cultural biases, the medical or nursing education process, acculturation to the health care system, and the attributes and attitudes of individuals seeking care.

Preserving traditional midwifery practices and providing allopathic medical care cannot be mutually exclusive if midwifery is to become mainstream.

The continued existence of midwifery requires individual and professional resiliency, as well as satisfaction with our ability to practice competently in a manner that is consistent with the core philosophical tenet of midwifery which honors women‘s reproductive function, including birth, as a physiologic process. Midwifery affirms the value of women, views birth as a powerful transformational life event, and recognizes the importance of family in every configuration in which it exists.

By reaching out in a respectful manner, one that honors women and men, midwifery and medicine, hospital birth and homebirth, technology and touch, midwives can become the bridge to bring midwifery to every setting where women receive care.

Nell Tharpe, CNM, has worked with birthing women, newborns and midwives since 1980. She teaches through Midwife Publications, the Midwifery Institute of Philadelphia University and Birthwise Midwifery School. She is the primary author of Clinical Practice Guidelines for Midwifery & Women‘s Health (Jones & Bartlett Publishers).


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