A Midwife for Every Community

Today is International Day of the Midwife, and it has me thinking about how to best honor my sisterhood of midwives--those who are currently practicing and also the midwives who came before who paved the way for me to be "with women."  The fact that there is a single midwife present today is a miracle given that our tribe has suffered outright persecution. It is estimated that in the middle ages nearly 30,000 midwives were killed over 150 years. More than lives were lost,  centuries of oral traditions surrounding birth which likely included wisdom regarding use of local plant medicines for pregnancy and birth and a greater understanding of how to work with our natural physiology were wiped out. It is even reported that midwives prior to the middle ages were keepers of  so-called "women's wisdom" about how to prevent pregnancy.  Despite the assault on midwifery, it has proved to be a calling that will not go away; yet, continues to face challenges.  

In modern times, midwives deal with issues of legitimacy in a world of highly medicalized obstetrics. In the US, for instance, midwives have made great strides, but messaging our value to the broader population has been difficult. Midwives catch less than 10% of all US born babies, even though the research shows that midwife-led care has excellent outcomes. While as a nation we are in the midst of  a maternity care crisis that desperately needs what we have to offer.  

  • The US performs poorly in regards to infant/maternal death and morbidity rates when compared to all other industrialized nations. 
  • We have dangerous obstetric shortages that are only expected to get worse. 
  • Women are overall dissatisfied with the current model which leaves many feeling traumatized as they take on the role of mothering.  
  • With all these problems we still have the most expensive maternity care system in the world.  

I think we can all agree on a few things:

1. Now is the time for real and dramatic changes to our maternity care model.

2. Women & their families deserve our best.

3. It is possible to transform our system. Midwives are poised to take the lead, but we can not do it alone. 

Multiple studies have concluded that midwifery-led care improves outcomes and reduces costs. With the evidence in our corner, how do we overcome the barriers and  move midwifery into the mainstream? I propose we look to our roots,  in days gone by, each community had its own midwife. She served as the matriarch of her village, a trusted support for families. A midwife for every community, it can happen, but the first step is to dare to imagine it. 

The model of my dreams would look like this: 

  • Every community would have a midwifery service
  • Midwives and obstetricians would create mutually supportive partnerships where both groups would approach the other with respect and curiosity and value the unique ways that they each serve
  • Nurse-Midwives and Certified Professional Midwives would join forces and collaborate for the advancement of midwifery and the betterment of all women
  • Women would have access to birth in any setting: home, hospital, or birth center and midwives would help women decide based on risk stratification
  • Midwives would be present for every birth, even when interventions are needed including cesarean sections
  • Pregnancy and birth would be honored and celebrated for the transformative life experience it is, instead of feared and treated like a medical catastrophe waiting to happen
  • Nurses would be trained in normal birth, and labor support
  • Labor and postpartum doulas would be available to all moms
  • Immediate skin-to-skin for babies would be championed
  • Easily available lactation support
  • In home postpartum visits
  • Our nation would join the rest of the world and offer paid maternity leave for at least 6 months
  • Women's health would have a holistic and integrative approach

What are your thoughts? Comment below so we can co-create a new maternity model.  If these ideas seem far-fetched, I would recommend we all look to the New Zealand Midwives for inspiration. Within a span of 20 years, they were able to go from not having midwifery care at all, to an autonomous system where midwives do most of the deliveries. Anything is possible.  Now is the time to address the problems facing perinatal care. Whether you are a mom, a dad, a grandma, midwife, doctor, preacher, engineer, or nurse we all have something at stake. If we work together we can transform a broken system, into a model with the well-being of the mother at the heart of everything we do.