Sunday, August 9, 2009

Who Is A Midwife?

The literal translation of “Midwife” is “WITH WOMAN”. ‘Women being with women’ during birth has been around in every culture for as long as women have been having babies – the tradition of midwifery is more ancient than its title, than western medical knowledge and the medical profession. By right of pre-existence, traditional midwifery should remain the defining standard. Midwifery is not a “branch of nursing”, nor did it arise out of nursing. It is unfortunate that both birthing and the traditions and knowledge of those dedicated to the care of birthing women have been so thoroughly medicalised. Midwifery is also not confined to the birthing room. The literal translation of midwife - “with woman” - implies a companionship through all of life’s journeys – the onset of menstruation, sexual health and well being, pregnancy, birthing, motherhood, menopause. It is the passing of women’s knowledge from generation to generation. It is the keeper of women’s power.

The political debate over who has the “right” to call themselves “Midwife” continues and feelings are passionate on all sides. You may have noticed that I use the term “birth worker”. I love the term midwife, and hold dear to all that it traditionally implies, but I have reluctantly changed my terminology because I disagree with the way modern midwifery is practiced, and I disagree with the educational content of midwifery courses as well as the way midwives are “trained” and regulated. Traditionally, midwives were the women in the community called to “be” with women – companions for those life-issues women faced, particularly in pregnancy, childbirth and early parenting. It is unfortunate in my opinion that the art and wisdom of midwifery has been consumed by a western medical and educational philosophy and has been moulded into something it was never traditionally known as. Midwifery has been organised into a profession, and duly regulated, controlled and managed. While there are some very good arguments for the benefits of this (such as creating consistent standards for the safety and well being of women), the end result is a profession dictated by medical, legal, and liability policy – and women’s right to accurate information and informed choice gets lost under the bureaucracy. The control of woman's choice has been lost in midwifery's professionalism. Midwifery in its traditional sense is woman centred, not midwife centered, or medical knowledge centered; and midwives that have been traditionally trained have felt themselves “out in the cold” and no longer allowed to use the term that has always described what they do – ‘midwife’. I have had the privilege of knowing and learning from some extremely gifted and knowledgeable traditional midwives and have a great respect for the service they provide. What gives the medical profession the right to high-jack the term that was originally applied to a traditional practice, change the practice, ridicule traditional knowledge, and then forbid “true midwives” to practice in the setting they have always practiced – the home? I’d just like to make it very clear that a medical education and registration certificate does not a midwife make (in the true traditional sense of the word). While for the moment I am still a registered midwife, this is why I call myself a “birth worker” and what I do as “birth work”.

Some feel the traditional and the medical can be blended successfully, and others believe that this is only partly true. Some believe that there can be no mixing, and that once a pregnancy/labour/birth departs from what is physiologically normal, than it transitions into needing medical help, and therefore into a differnet model of care entirely. Some home birth midwives feel that the responsibility for care is theirs, and operate according to medical guidelines (though generally with more relaxed boundaries, and certainly with more time to build a caring relationship with you). My philosophy is somewhat between the second and third philosophies - that it is my responsibility to provide “nurture” and all that you require to facilitate your own birth, sometimes my medical knowledge is helpful, but in most scenarios, if medical care is needed than it is outside my area of expertise, and enters a different model of care. I will always remain and be 'midwife' to you, your nurture is my responsiibility, but if you require medical care, than that 'care' belongs to the medical model. Some women feel they can trust a midwife who has the official education and registration more than someone who does not have these things but has dedicated their life to learning, wisdom building and being with women. When you know little about a subject, you feel someone whose practice is regulated must at least know what they are talking about. There is nothing wrong with that – it is of primary importance that you trust the person you ask to assist you during your birth. But if you take the time to learn a little about your subject, you will have the tools to be able to choose the birth worker who suits you the best – registered or not; and the freedom to be in charge of your own pregnancy and birth. It is so empowering to make your own choices and not need the ‘OK’ of a medical professional to do what you know is right and safest for your individual circumstances. My belief is that women need to take responsibility on for themselves, and commit to learn more about the process rather than rely on someone else to spoon feed them and keep them safe. Some women do not wish to take on this responsibility and it is a very wise woman who recognises what her needs are, what her beliefs are, and choose an appropriate birth worker accordingly. If you choose hospital or home, registered or unregistered, medical philosophy or natural philosophy it doesn’t really matter – the important thing is that YOU have made your choice – one that is best for YOU.

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