Midwifery: The Oldest Profession in The World
by Jennifer Houston

I couldn't help overhearing two women talking in the store the other day. One women said, "I'm pregnant and going to a midwife." The other women sounded shocked: "A midwife?! Are there still midwives anymore? Are they legal? Is it safe? What do they actually do?"

I was both (happily) surprised to hear someone say she was using a midwife, and distressed to hear her friend's response. Unfortunately, the majority of women in the United States, where medical care is big business, don't use midwives. Midwives attend only some 11 percent of all births in the USA. I was disappointed that her friend thought that midwives were likely to be untrained, unqualified, illegal or unsafe. It was particulary worrisome to realize just how uninformed the "average" person is: rarely knowing that midwives are the guardians of normal natural birth, and hold an essential position in the medical communinity, even if often underutilized, she or he often seems to find it hard to believe that the contemporary midwife even exists!

This scene compelled me to reflect again on how far midwifery, the art and science of being with women, still has to go to become an available, accessible, affordable part of "mainstream" healthcare in the U.S., as it is in other countries. Midwifery in European countries, where the business of being born isn't economically motivated, is well known. Midwives attend 85 percent of all births in these countries. In spite of all our technology and the amount of money spent on maternal health in this country, our rank in terms of maternal and infant mortality/morbidity is only eighth worldwide in, with countries such as Norway, Canada, the United Kingdom and Sweden all demonstrating much better outcomes while spending much less money. (Statistics come from the World Health Organization website).

Midwifery is the art and science of attending women in childbirth. The practice dates back to ancient biblical, Greek, and Roman times. It declined in the Middle Ages, when childbirth carried a high mortality rate for both mothers and infants, but advanced considerably between the 17th and 19th centuries. Later, with advances in obstetrics and gynecology, women gave birth in hospitals. In the 1960s women started demanding more freedom and choice in their own health, particularly regarding birth. Births attended by midwives increased dramatically, and have doubled since then.

What do midwives do and why would women choose one? In the simplest terms, a midwife is a person (usually a woman) who is knowledgeable and experienced in how to help a woman have a healthy, normal pregnancy and give birth to a healthy baby. Midwives tend to provide the time and attention pregnant and birthing women need. Ideally a midwife's education, counseling and support come before, during and after the baby is born, and do not interfere with the natural process. Midwives — by teaching, empowering, supporting and believing in the women's own capacity to safely give birth naturally — make it less likely that intervention will be needed. Because they are experts in normal pregnancy and birth, midwives are experienced in the variations of normal and recognize the early signs of conditions that are not "normal," including medical conditions or complications that may occasionally arise. They work as part of the health care team and can consult or refer to a physician if needed.

Midwives emphasize a healthy lifestyle and preventive care. They take the time to build trusting, supportive relationships with their clients. In labor, the midwifery model encourages an atmosphere of freedom to move, eat and drink, use of massage, water, music, breath, and empowering, supportive language and attention. Midwives don't "prohibit" or "allow," but patiently support and guide as needed, respecting the birth process as it unfolds each time in its uniqueness. Midwives trust in birth and know: birth is as safe as life gets. Midwives understand the interconnectedness of all things — they have seen the domino effect of the interventions so routinely used in mainstream hospital birth, when often one medical procedure leads to multiple others, even when no procedure was needed in the first place.

In an ideal world all hospitals would provide the midwifery model of care, but at present this kind of care is most readily found in homes and birth centers. The institutionalization of hospital birth, overuse of technology, and lack of support to the natural process as well as increased use of epidurals have contributed to rising c-section rates in America, which now stand at 25 percent (much higher than in countries with a less profit-driven medical system and a wider use of midwifery).

Consider that most doctors never see a natural birth during their training, let alone learn how to support one. Mainstream medical training focuses on pathology; by that model every pregnant women is looked at first and foremost for her potential to create complications, rather than as a candidate for a normal, natural pregnancy and birth. Midwives provide full information about all recommended tests, procedures and treatments so you can make informed choices about your care. Midwives can help avoid risks that are associated with many standard medical techniques and hospital protocols.

What if you're pregnant now or considering becoming pregnant soon? How can you receive the midwifery model of care? Educate yourself. Ask yourself what's important for you and your baby's birth and become a participant in the process. Ask detailed questions when choosing your caregiver and deciding where you want to give birth. When you locate a particular caregiver, ask others who have used that person.

Someday, midwives will be available in even the largest institutional settings and when a woman says she's going to a midwife everyone will know that midwives are legal, safe experts in natural birth. Midwives always have been here and always will be … sometimes we just need to look a little deeper than the mainstream and find what's out there.

Jennifer Houston CNM MS is a mother and grandmother who has been a practicing midwife since 1973. For nine years she was the founder/director of Midwives for Midwives, a non profit women's health and birth center in Antigua, Guatemala, where she ran a midwifery training program for both indigenous Guatemalan midwives and foreigners who came to study. She continues to provide midwifery care to women in their homes and can be reached at 518-678-3154 or womanway@aol.com.