Midwives are trained to acknowledge, respect and treat the excessive fear that most American women now bring to birth. This fear is understandable in light of the history of modern childbirth; however, it must be addressed if women are to have normal births. Suzanne Arms (www.midwifeinfo.com)
To be powerful in life, birth and death, the beginning and end, the during and in between: the transitions, most of all the transitions…if I had known then, what I know now, I could have made it through transition without an epidural. I did not want one, but fear set in when my water broke full of meconium and I was suddenly eight centimeters. Fear set in as it often will in a medical environment when you are left to labor without any real support, with a partner still traumatized from your previous hospital birth, with a nurse whom you do not know and who doesn’t know if the tub has jets or how to run it because no one had ever used it to labor before, when everyone is scared--everyone including your doctor.
The midwife considers the miracle of childbirth as normal, and leaves it alone unless there’s trouble. The obstetrician normally sees childbirth as trouble: if he leaves it alone, it’s a miracle. (Sheila Stubbs, quote from Midwifery journal)
My first labor and delivery was attended by a southern Baptist doctor who almost thought he would have to give me a c-section three times over, but then said that God had pulled me through, but that he was “to witness, to us (my husband and I) because we did not know him …” This left me feeling extremely distressed in the midst of my post-partum hormones raging as much as his statement made me rage. After a very long labor ending with my child being sucked out of me by vacuum extraction and then pulled out with forceps. I wanted to shout back at him, and let him know in no uncertain terms that God was teaching him a lesson: that women sometimes need a long time to labor and that eventually the baby will come out, that threatening with a c-section isn’t go to speed things up. But, I didn’t say anything. After all, he was the doctor, the authority figure. I was the first-time mom, at his mercy.
Each woman having a baby in hospital is transformed into a patient. She is a temporary member of a tightly organized, hierarchic and bureaucratic medical system. (Sheila Kitzinger, Rediscovering Birth)
I’ll never forget at the birth of my first son during the last pushes, I said, “Dr. Richmond, please hold my hands ( I needed to sit up and pull on something between my legs).” I felt so stupid when my mother in law and nurses said, “he’s sterile, he can’t touch you.” He was delivering the child inside me—but he could not pull my hands to ease delivery? What blasphemy. This would never happen with a midwife in your home. A midwife would never look at you with disdain and say, as one of my doctors did, after being asked if you could squat while laboring, “I’m not getting on the floor to catch your baby.”
My power was taken away when I become a patient instead of being what I was: a birthing mother. My husband was unsupportive of homebirths due to the birth trauma that he experienced with our OB in Alabama (that man put the fear of birth right into my man), and unwilling to pay more than the $10.00 that the in-network prenatal care and hospital delivery would cost under our HMO. So, for our second child it was back to the hospital for me. I believed and trusted my doctors until they gave me information that was contrary to my own research. For example, my doctor told me that an episiotomy would prevent damage to the pelvic floor. I had just read In A Good Birth, A Safe Birth: “In their (Enkin, Cheirse, and Chalmers) complete review of world literature, the authors found no research to support a medical need for episiotomies. ‘In fact, the liberal use of episiotomy is associated with higher overall rates of perineal trauma.’” (Korte and Scaers) The doubts began, and finally I began the process of trusting myself more than the doctors.
I have given birth twice to two healthy beautiful boys. The circumstances under which they were born were not everything that I wanted, but fortunately I was able to deliver vaginally albeit with every intervention besides surgically removing my child. But what about the women that are cut open for convenience sake? Recently, a woman was told that she would have to have a c-section because her baby was too big. Her baby came out a normal eight pounds. This is common place. It should be against the law. It is against women’s rights. What about the women at risk to lose their fertility because of uterine scars from repeated c-sections? What about the women who are denied Vaginal birth after Caesareans (VBACs), and who would put their lives at risk with one more c-section? These women have to turn to midwives for Home births after caesareans (HBACs), or VBACs and in some states it is not legal for a midwife to attend a homebirth, especially not an HBAC. So, a woman must break the law to get a good birth, a safe birth? This is insanity. This is birth in America.
Consumers must be given a choice as to whether they want a techno-medical model of care (as is given by the majority of OB/gyns) or a midwifery model of care. Different types of midwives are in practice and they range in their approach from a more medical paradigm to a more nurturing, intuitive approach. There are Direct Entry Midwives also known as “lay” midwives, Certified Nurse Midwives (CNMs), Certified Professional Midwives (CNMs) which are licensed direct entry midwives (DEMs). CNMs go the nursing school route, while DEMs develop their practices through the more traditional route of attending births with mentors, and apprenticeships. CPMs are essentially certified DEMs. As CPM and Midwifery activist Brynne Potter states, “The CPM was “midwifed” by the Midwives Alliance of North American (MANA) and NARM and it is still a toddler among it’s peers.
Hopefully, in the years to come the CPM will serve as a model for the validation of lifeskills that are necessary to a healthy culture and that cannot be taught in a classroom setting. Some midwives, especially those working in a hospital will follow a more techno-medical model. “First and foremost, we have the individuality of the midwives ... This is always the case and it is why every woman should not just have access to a midwife, but access to many midwives to choose from. Every woman should be able to find a midwife who’s philosophy of birth and the role of family in the childbirth cycle are perfectly matched. As well as a level of training and background that is most comfortable to them.” (Potter, Brynne)
There is a vast difference between the two models of care. A woman who is at low-risk with her second or third child may be comfortable with a DEM or CPM birthing at home. While a first time mother may be more comfortable with a CNM in a birthing center. Ina MayGaskin describes the techno-medical model of birth (Ina May’s Guide to Childbirth):
Mind and body are considered to be separate within the techno-medical model of birth. Because of this, emotional ambience is of importance only when it comes to marketing the service. Where the techno-medical model of birth reigns, women who give birth vaginally generally labor in bed hooked up to electronic fetal monitors, intravenous tubes, and pressure-reading devices … Labor pain within this model is seen as unacceptable, so analgesia and anesthesia are encouraged.
In sharp contrast to this she describes the Midwifery model of care:
Good research show that when the midwifery model of care is applied, between 85 and 95 percent of healthy women will safely give birth without surgery or instruments such as forceps and vacuum extractors. Within the midwifery model, medical intervention is inappropriate unless it is truly necessary. Labor has its own rhythms, so it is not expected to conclude within any rigid time limit.
”The findings of the 1998 Pew/USCF Report on the Future of Midwifery … note that although nurse-midwifery and direct-entry midwifery midwives have their differences, ‘most midwives have much in common, including a philosophical adherence to the midwifery model of care.’” (Kennedy, Holly Powell, 5)
I believe that having prenatal care that includes a wise woman midwife who can tell you amazing things about the power of your body and the power of birth that you would learn to trust your care provider and most importantly your body and, your inner tuition. During birth, empowered by your knowledge, confident in your choices—you could relax, and labor the way nature intended without monitors strapped to your belly, IVs stuck in your arms, and various nurses sticking their long fingernails up your crotch every thirty minutes. As they say, Peace on Earth begins with Birth! Think about it.