Changing Birth Practices
by Jan Tritten

[Editor’s note: This article first appeared in Midwifery Today, Issue 107, Autumn 2013.]

Changing birth practices is as hard as changing culture, because that is essentially what we are trying to do. Culture is often against us. We fault doctors and the medical approach to birth (and rightfully so!) for not giving up practices, such as episiotomy, time limits on labor, controlled pushing, separation of mother and baby, not providing skin-to-skin time and now the bad habit of 30, 40, 50% or higher cesarean rates when 5–7% is more appropriate. Often these cesareans are for iatrogenic problems, such as inducing unnecessarily, yet we think we do not cause problems or have practices that are “all that bad.” But don’t we have a hard time giving up unneeded vaginal checks, talking needlessly, using Cytotec and other harmful drugs, disturbing motherbaby unnecessarily in the first hour after birth and on and on?

Doctors horrendously make excuses, and the worst thing they do is to put blame back on the mom saying things like, “She asked for a cesarean,” but neglecting to say that he told her the baby would die without one. Midwives aren’t blameless, either, often having to follow certain protocols because our license depends on it and not because it is the best thing for motherbaby.

…if we prepare mom well in pregnancy, the birth will almost always go well.

We must be ever so careful in what we write into laws, licensing agreements and protocols. We must be careful with someone else’s birth; it is not all about us, it is not our birth. We are there for mothers and babies, to do what is right for them to the best of our knowledge and understanding—not to simply follow the whims of our birth culture. We do not find truth in birth culture. We find it, if we seek it, in our God-given ability to think.

Have we become so mother-centered that we have forgotten the baby? But don’t forget, the midwife is for the baby as well. What we do to or for motherbaby will last for both of their lifetimes. Great prenatal care is absolutely essential. Each mother needs and deserves time. It takes time to help her understand how to take care of herself and her baby in pregnancy and also to prepare for birth against the culture she is living in. My friends Verena Schmid from Italy and Fernando Molina from Venezuela tell me that if we prepare mom well in pregnancy, the birth will almost always go well. Both of these dear friends have excellent programs for preparing expectant moms.

So when we attempt to change birth, we need to know we are up against culture and to go forward with this in mind. But we have to know enough about what the current myths are in order to change ideas. An excellent book to help discern truths from myths is Henci Goer’s latest book, Optimal Care in Childbirth, co-written by Amy Romano. Changing our culture for better birth is going to take a lot of work on the part of midwives and other birth workers, as well as the support and help of mothers who ultimately will be served by this change.

Sara Wickham wrote an article about changing birth back in 2000, but her words are still very relevant: 26 Ways to Change Birth Globally. Our website ( has many great articles on birth change. One of the great aspects in our attempts to change birth is that there are so, so many of us working toward this common goal, but we need to work really hard at having a spirit of unity among us. Though the birth workers have increased, the conflicts have, too. We all want what is best for motherbaby, even if we go about it differently. Can we start respecting each other as we respect motherbaby? Can we begin being encouragers of each other? Can we start mentoring the young and enthusiastic?

A birth revolution has begun. Diana Paul is leading us in this great movement that I hope you will all be a part of. We had a wonderful rally at the Eugene, Oregon, Midwifery Today conference. The revolution is based on the book From Dictatorship to Democracy by Gene Sharp, which was responsible for much of the Arab Spring. The ideas of this humble man really work. The book contains 198 ways to make change. Diana took 50 of them and applied them to birth. Our color is turquoise, which means liberty and our song can be heard on YouTube (search: birth revolution). Diana’s article on the Birth Revolution will be featured in Midwifery Today, Issue 108, and she has written a small piece for us in this issue’s Cards and Letters section.

Take advantage of social media and the many ways you can work with the Internet to make change. Most of all, talk to anyone who will listen about the beauty and wonder of birth. We can make these needed changes if we just keep doing what we are called to do.

Toward better birth,

Jan Tritten

Jan Tritten is the founder and editor-in-chief of Midwifery Today magazine and a midwife who was in active practice from 1977 to 1989. She became a midwife in 1977 after the powerful homebirth of one of her daughters. Her mission is to make loving midwifery care the norm for birthing women and their babies throughout the world. Meet Jan at our conferences around the world! [ PHOTO BY ANDREA NOLL ]

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