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Thursday
Jan132011

Defining Mid/Medwife

While the term “Medwife” is volleyed around birth circles on the Net and in real life world, I’ve wondered, for a long time, what the definition of each would be if we were to create/give them one. Sure, I’ve read numerous descriptions of what the differences are between the two, but never in a thread such as this (that I’ve seen).

I do know the strong feelings people have about these terms and really do want to continue the discussion, but ask everyone to please remain civil. (Isn’t it kind of sad that I even have to mention it?)

So here is how the thread went down on my Navelgazing Midwife Facebook  page. My comments/thoughts are interspersed through the piece in bold italics. 

DH1: MIDwives: Trust birth and do not interfere in the birth process unless absolutely necessary. They are highly educated and use that to their advantage in knowing when to or, more often, when not to interfere. They understand there is a wide variety of normal and that being "with woman" does not mean to control them.

MEDwives: Use the medical model of obstetric management to control birth using medicine, herbs, expectations, etc. for all kinds of ways to start, augment and speed the birth process. This variety is found more often than not working in the hospital setting although there are some still controlling birth in home settings as well.

KB: So do MIDwives convert to MEDwives and cancel out their trust in birth when the shit hits the fan on a perfectly unintervened birth and they need to resort to medicine and herbs?

JW: DH1 hit it with the control factor.

DH1: No. Midwives intervene as well but only when absolutely necessary... which is not very often. Medwives seem to intervene on a regular basis as "protocol". That is the different in my eyes.

KB: MEDwives are not as "highly educated" as MIDwives? Please explain that one.

RP: I have seen some "medwives" who you could not even tell the difference between them and an OB. In fact, my OB is more open to alternatives and has a lower rate of intervention than they do. I guess it was fairly obvious to me that there were what many would deem "medwives".

DH1: No, they have different training. Medwives are trained that the birth process is broken and needs to be tampered with in order to function properly. Midwives are trained to trust the birth process with a very thorough understanding of the physiology of birth, female anatomy and most importantly patience.

That you said “…trained that the birth process is broken and needs to be tampered with in order to function properly,” I really am baffled where that comes from. While I admit there are plenty of midwives who’ve been quick on the intervention draw (and I’m sure I’ve done that myself), having seen the curricula for midwifery schools (CPM & CNM), I have a hard time believing any midwife is trained or believes the birth process is broken. Maybe it would be easier if you could share some examples of what you mean.

I do think there are midwives who use technology for convenience’s sake, similar to OBs, but that’s different than believing the process is broken.

Also, if you’re looking at who has the more thorough understanding of the physiology of birth and the female anatomy from an educational standpoint, that is most certainly a CNM. CPMs get a fraction of A&P compared to CNMs.

RNK: With DH1 100%.

NgM: clapping hands Can't wait to get into this one later! grinning You all are wonderful! Thank you so much for your candor. This will be a hot button topic and already there's lively interaction. I think this topic is soooo worthy of discussion. Thank you, in advance, all of you willing to share your thoughts, even if they seem not to be the popular one.

KB: I wonder how you've been able to thoroughly assess the training modalities of "medwives" and "midwives" to come to that conclusion, DH1. And who are you talking about exactly. I've known many a "medwife" DEM and probably more "midwife" CNMs in my 10+ year career. I think it's a pretty faulty blanket statement to make and there is a lot of magical thinking going into the whole "midwife" vs "medwife" discussion.

AL: The difference is in the eye of the beholder.

Agreed.

VM: I think it all depends on the perspective of the person using the term. Where I live, there aren't many midwives who aren't CNMs. The CNMs are controlled via their practice agreements and must be "medwives" in many cases: intervening when it is questionable, whether it is necessary, bullying moms into tests and ultrasounds that aren't supported by evidence and not supporting VBAC. Supporting women in this environment, it would be very hard to call any midwife who attends a homebirth a medwife. Because at least she trusts the process so far that she is willing to attend in a home.

What does bullying a mom into tests and ultrasounds look/sound like?

JWP: I don't think training has anything to do with it in most cases. Experiences can shape people after their training, things they've seen can make them change. I'm doulaing for a mom anytime now who is using the known medwives of the area. They are highly watched and controlled by their backup Drs. So while maybe they believe this is the right way to handle a pregnancy, maybe they don't and they don't have many choices. It's either quit and leave even fewer midwives here, switch places of employment to the other MW office in town or just deal with it ‘til we can get laws changed for autonomous practice.

SGM: I think midwives are comfortable being "with women" and trust the process, their own skills and instincts. I think medwives are well meaning, but have been jaded by the OBs that "oversee" them, and the medical model of care in general. By attending to women in the hospital, some midwives simply acquiesce to the status quo, and unfortunately become medwives. They lost their passion along the way, and it has become just a job.

I think this comment alone confuses me more than any other. That a midwife in the hospital who adheres to protocols –that she believes to be true- because she does, you feel she’s lost her passion? That it’s just a job? How did you come to that conclusion? Because she doesn’t buck the system, she doesn’t have passion? Because she works with a degree within institutional walls, her entire practice is discounted?

I rarely see the acknowledgement that not all midwives enter the profession to Change the World of Obstetrics. Not all midwives, especially CNMs, believe homebirth is the safest place to birth. And, just because she doesn’t agree with you (global you), doesn’t mean she’s a shit midwife. She’s just not the midwife for you. And not all women who choose midwives are looking for the “enlightened, spiritual” birth experience. Many women do want the kindness and care CNMs offer, the respect for choices, the time with listening and the patience with interactions. A midwife who adheres to and honors protocols, in my opinion, is not the definition of medwife; it’s the definition of a midwife who feels the protocols and rules help keep mom and baby safe. Just as you might disagree with that definition, she, too, might very well disagree that not using protocols is the safest route for both mother and baby.

KC: Medwife - manages birth for her convenience (or fear), causes herself to be "needed" yet still, usually does so with the best but misguided intentions.

Midwife - keeps her hands to herself unless nature requires it, even when it’s hard not to meddle, she addresses her own fears internally and not externally on mom or baby. She lovingly "life guards". You know if a lifeguard tried to rescue a strong swimmer it would cause drowning, hence a need to be rescued because of the "rescuing'. My midwife crotchets baby hats to keep her hands busy when the urge to "help" gets strong. I am so grateful I can trust her to be a guardian not a manager.

How does a midwife manage birth for her convenience (or fear)? Examples would be great here.

And just as a point of arguing (more), a lifeguard who tries to save a strong swimmer would not, at all, cause a drowning. Bad analogy. (I’m a lifelong swimmer and a retired lifeguard.)

DB-H: K, a DEM (Direct-Entry Midwife) can still practice obstetrics-based care. It’s more of an attitude and approach than credentials.

There are DEMs who encourage augmentation of labor with natural means because mom's tired, baby is big, etc., that check dilation way more than even high risk OBs do. This to me is a medwife.

A midwife encourages the tired mom, telling her how important these last few days/weeks inside are for her baby. She watches the labor, only assisting when medically needed and not for the convenience of herself or others.

Where are all these midwives who encourage inducing or augmenting labor because the mom is tired or because the baby’s too big? Do you mean CNMs? I’ve known a lot of midwives (and have disagreed with puh-LENTY of them in how they practice), but cannot even think of one who practiced this way.

EM: Medwife is a boorish, annoying term made up by some midwives to criticize a colleague.

JD: I am in agreement with DH1, aside from the training... two women can have the same exact training, but come out the other end with different ideas.

K, I'm not seeing where anyone says midwife=DEM (or CPM) and medwife=CNM. I think we all know that isn't the case. However, it is known that CNMs (in the hospital) have more rules to follow.

RC: Where I live there is only one kind of midwife in terms of training and where they do births (both home and hospital). But the distinction stands. Medwives work from a place of fear. They transmit that fear to their clients. Fear breeds a need to control.

Describe the fear. How do they transmit that to clients? Please tell a story that shows a midwife feeding fear to the client.

KB: J, I know that no one has stated whether someone is a CPM or CNM, however DH1 did mention training so that is why I asked for clarification.

DD: To me, I thought I knew the definition of MEDwife. Then my cousin had her baby at the hospital with the "midwife" staff.

They are REALLY not midwives there, so now my definition of MEDwife is

MEDwife: Woman doctor who is called a midwife by the hospital so that they can pay her less. Due to being paid less, she develops a complex and must prove that she is more qualified and better than the attending doctor by performing more interventions and "saving" more babies than him.

Be wary the surgeon in midwive’s clothing Just because they're female doesn’t mean they are a midwife, no matter what the hospital says.

DH2: On paper, they are no doubt equally educated. In practice, some might be more willing (hopefully all good MIDwives) to use patient-oriented, mother-friendly techniques to help a mother get the birth she wants. A medwife, in my experience, is just an extension of the OB - who might not be interested in anything other than getting the baby out at any cost, usually at your expense, and call it a "good outcome." Grr.

MNK: Midwife describes a professional credential, which typically entails a set of knowledge, values, attitudes, skills and abilities. MEDwife is a stereotype that is often used by people who are labeling a group based on assumptions. Stereotyping fails to take into consideration the unique complexities of individuals.

Here, here!

KP: I've jokingly said that a "medwife" is anyone who is "too medically minded," based on the opinion of the person defining the midwife's practice style; and a "madwife" is anyone who is less medically minded than the person wishes.

To me, a "medwife" would include those who have a high induction and/or Cesarean Section rate, and who basically manage pregnancy as if they were the stereotypical high-intervention obstetrician.

BP shares a post she wrote on this subject.

MC: If a midwife can legally use medications in labor/birth as well as other medically minded interventions and she resorts to using the meds/interventions FIRST then she is a medwife. Midwife means with woman. Bringing her fears into the birth place with her makes her unable to truly be with the laboring woman. I agree with M, too- it is a stereotype we commonly use for CNMs.

Question: So if a midwife isn’t to use medications and interventions first, what is she to use? What situations are you specifically speaking about? Is there any situation where medications or interventions are acceptable as a first line of defense?

NgM: Very interesting, all of you.

I've heard the terms compared for many years now, have been called each myself. I've asked for definitions several times, but have rarely heard an answer. This is very helpful as well as enlightening.

I've even heard such a tight definition as any midwife who carries medications is considered a "medwife." I guess if a midwife carries meds, she doesn't Trust Birth enough? I absolutely do not understand that mindset.

My experience only: I don't think I've ever met a midwife (CPM/CNM) who pushed for unnecessary inductions or epidurals. Perhaps within protocols, but not just because a mom's tired of being pregnant or because it's convenient.

It confuses me that people get all cranky about protocols. We all operate in this culture within many different sets of protocols... rules of the road, the handling of money, the education system, our legal system and more. With some, there are accepted ways around/through them and there are certainly unacceptable ways to deal/cope with them.

How can women think there won't be protocols/parameters with something as crucial as the life and death of a baby? How can women think anarchy is acceptable in birth? I don't mean the pushing of constraints or questioning authority... not at all... but complete anarchy? (Is UC complete anarchy?) Are we to just leave birth 100% alone to do its thing without touching a woman at all? Ever?

The comments above speak about a midwife knowing when to touch a mom, when to interfere (hear the tone of that word?) to save a life, but the issue arises... WHO judges whether the midwife acted "appropriately" or was meddlesome? Is it the mom? The Medical Board? Grandma sitting in the room? The doula? Where does this judgment come from and why is someone entitled to confer the epithet of "medwife" on a midwife?

And, as I ready myself to leave homebirth midwifery, am I cranky about this topic because I've been called a medwife a lot? Does being a medwife have any part in my leaving midwifery? Leaving the practice of midwifery to women who don't think about the complications as deeply as I do?

Still listening and pondering.

MNK: Can you say dogma? I highly suspect that most of the folks touting this 'Medwife' dogma have probably never held the hand of a husband witnessing his wife suffering from DIC, having her uterus removed, and dozens upon dozens of blood transfusions after the 'Midwife' delayed transporting with a PPH, because she wanted to try to get the baby latched! (I'm an IBCLC, by the way) Part of being a MIDwife is recognizing when intervention is warranted and relying on your training and wisdom to guide your reactions (and certainly this doesn't happen by consulting with the 'family, and doula' (yep, I'm a doula, too) in the room!

Barb, this is your career, sorry to sound bossy here but don't allow other people to define your parameters. You have a solid head on your shoulders, skilled hands, and a generous heart. You, Barbara, are the epitome of a MIDwife in every sense of the word. As to who decides, well you have a scope of practice to adhere to and your training. I don't think you are giving yourself enough credit but that's my .02 worth. Trust Birth, , it usually works well, and when it all goes to shit, because it does on occasion, -and it will- trust your ability to recognize it and get the pair to a freakin' qualified Perinatologist. Don't let other people bully you either. Do what you need to and know is right. If it's not right for you now, take a hiatus, but if you want to persist in practice, go girl!

I appreciate that. As you know, the decision is made.

DH1: I think this matter is complicated as you so aptly wrote NgM. You are right, there is a lot of judgment in these words. I think it comes down to "Who's birth is it?" Is it the midwife's birth because she has protocols to follow and a practice to protect? Or is it the Mom's birth because she is the one birthing and this is her baby? Who is in charge here? One of them? Both of them? Who is MORE in charge? What about the baby or the partner? I'm not sure any of us have the answers to these questions as anyone deeply impacted and involved by birth would know there are no answers to these questions because every birth is different AND dependent on at least ONE person (mama, midwife and/or baby) trusting the birth process. If the "one in charge" does not trust the birth process, it is very likely the others won't either and this is where meddling comes in.

This birth trust does not come from credentials or training. I never said anything about CNMs or DEMs. It especially does not come from fear based on a few experiences gone wrong. We have to trust that women know what they want, they know how to give birth and their babies know how to be born - even after her birth attendant has had an adverse outcome with another woman. This does not mean she has to change her protocols for everyone thereafter. Every woman/baby is unique and every woman/baby deserves the chance to prove that interventions are not necessary without protocols being pushed on her because the "protocols, practice, law" says so. We all know right from wrong and can make educated choices that make sense for each situation.

I also agree that the distinction of medwife and midwife is painful to both parties (not to mention Mamas and babies). If we are to be honest with each other though there is a difference. It comes down to control. Who do you think is in control of this birth? Not responsible for, but in control of. Getting out of your own way to allow the birth process to unfold is what being a midwife "with woman" is all about.

After reading this comment, I started a post (that I haven’t finished yet) about how a bad outcome changes one’s practice. The short analogy is: if you sped through the intersection 1000 times without incident, but sped through once and had an accident that killed your child, how will that accident affect your driving forevermore, especially as you cross the intersection?

Watching a mother or baby die in birth cannot NOT affect you.

We are all products of our experiences. Women choose to UC based on previous experiences. Asking a midwife to not incorporate her experiences in birth, asking her to leave her accumulated knowledge at the door is absurd. We learn with each birth! Each experience builds on the one before, creating a block for the one that will come after. It is the midwives with many births under their belts, with many years of experience, that are most honored.

Regarding the control aspect, in the perfect midwifery/client relationship, each woman uses her strengths and leads her Self. The laboring woman is in control of her labor and birth. The midwife is in control of making sure the mother and baby stay alive… in fact, she was hired by the woman to do just that. And then, ultimately, the baby is in control… the baby guides the actions of the others around him/her. To me, this is symbiosis at its best.

SM: ‎"Blind maternalism is just as dangerous as blind paternalism" if I may quote one of my favorite OB/GYN buddies. I agree.

KB: ‎"Birth trust/Trust Birth" is a sales pitch and just as polarizing to this profession as the circular midwife versus medwife argument. It's interesting that not many midwives have contributed their two cents to this thread but lots of others have. I'd like to know when those of you who are the most critical plan to start your midwifery practice and if 5 years later you have a different opinion.

AHH: I agree with E and think that we midwives have enough resistance and criticism from the medical community in general and the last thing we need to do is echo their thoughts about us.

DH2: I'm just basing my ideas on the care I've received from midwives, versus what I read from very different midwives like Barbara and others. Very different care than what I received.

AKS: Honestly? I think it's a dumb distinction to make. There are good midwives and there are "bad" (unskilled, or controlling, or unkind, or a bad fit for a particular woman) midwives. I would guess there are DEMS, CPMs, and CNMs in both groups --and I would guess there are medically-minded midwives (who follow current standard medical practices, whether or not they are supported by evidence) and "alternative"-minded midwives (who also follow practices that may or may not be supported by evidence) in both categories.

NgM: It's been a hard day, so I'll try to keep my tone at a civil level.

1. We are all a product of our experiences. Anyone who thinks otherwise... or who thinks the experiences don't affect us every single day... is in serious denial.

2. There ...is NO WAY one (me) can watch a birthing woman die, right in front of her (me), and not have it affect her (my) practice as a midwife. The experience doesn't control my right hand and force it to rupture women's membranes or wrap itself like a boa constrictor around my head, controlling my brainwaves, but it most definitely colors my reality that women can -and DO- die in birth.

It (the memory) doesn't mean I sit wringing my hands, just waiting for my clients to have an AFE, but it does give me a gift (a GIFT)... the woman who died gave me a gift... of the deepest respect for life and its precariousness, even in birth.

I know there's so much more to say about this, but it's late.

And yes, #3 is it is so, so, SO easy for non-midwives to speak about what a midwife should or should not be doing at birth. I defy any critic to stand in my shoes... in any midwife's shoes... and then tell me what a midwife should or should not be doing.

My job is to keep two people alive. With that statement comes an endless list of scenarios and what-if's that cannot be rattled off in a Facebook (or blog) discussion.

DH2: Given what I know just from reading your blog and hearing you talk so passionately about birth, Barbara, I would not call you a "medwife." You respect birth, and do not a take a cavalier approach to it - with good reason (as you just stated). If someone hires you to help deliver their child and then calls you a medwife, then it sounds like what they want is perhaps an unassisted birth. Because you already sound pretty hands-off unless there is a reason not to be.

MG: I agree that the label is harmful. So often those who are labeled "medwives" are only following protocols they wish they didn't have to follow... so why are they hospital midwives? Because they believe they can make a difference in women's births by offering them hospital-based midwifery care even with those protocols as opposed to giving birth entirely over to OB's. And from what I've seen, they are right, and do not deserve to be insulted for going to the front lines for women who for whatever reason aren't having a home birth. They work hard for the benefit of women. And there are midwives who are disrespectful of women with any or no letters after their name and who work both in and out of hospital.

On another note, using medication to save lives and interventions to avoid larger interventions is prudence, not over-medicalization. 

One thing is clear: Medwife is an epithet, hurled at a midwife who, for whatever reason, isn’t aligned with the woman spitting out the word. As KB says, this is one of those circular discussions and I’ve been watching it go ‘round and ‘round like a playground ride for years. I don’t expect it to stop anytime soon.

Wonderful midwife Pamela Hines is more diplomatic than I am (as usual). She says:

"There are midwives for every family. If you have specific expectations, only communication help you decide if that midwife is right for you. While I do hear of midwives with a bit of a 'bait and switch' persona in labor versus prenatally, this is not the norm. I hate that people decide that their idea of care should be the norm for every other woman in the world."

Brilliant.

    Me doing a vaginal exam on a mama who was pushing for quite awhile with no forward movement. We eventually transferred to the hospital where she did deliver vaginally; baby'd been quite acynclitic. Anecdotally, this was the one baby I caught in the hospital.    
                                                                                                                                                                                      

Reader Comments (13)

Had a midwife (CNM) for my last birth. She was restrained in some ways, I could tell. Firstly, she made sure to tell me not to mention drinking in labor... just to drink. She was diffusing a situation where I had gotten defensive immediately when the triage nurse said I couldn't drink and I argued. Privately, it was okay for me to drink...but we were not to make a big deal of it. I was told by this midwife if I had a breech baby we would turn it. I said, "but if baby is persistently breech, I'd like to try a vaginal birth if in a good position to do it" and she replied, "well, we'll turn the baby. If baby stays breech there will be a c-section, but that won't happen because we can turn the baby." I learned from a doula that the CNM had in fact done breech birth in the hospital, but since she was in a new group now, and at a different hospital, it might be against policy for her to do it. She did keep the monitor on me despite my desire avoid constant monitoring. Baby was having decels OR we were moving so much it was hard to get a good trace. She didn't insist on me being in the bed though, poor thing held that monitor on my belly for a few hours straight until she finally asked the nurses to stick around and help out by doing it so she could do something else...which was to give me massage. She did break my water, an intervention I really didn't want but agreed to. How could she know? I am an easy one to lead while in labor...so my midwife was doing what she thought would bring the baby faster and relieve my anxiety (I had a clock fixation and was very nervous that day). She did what she could to meet my needs, did some thing maybe for convenience, but still, she was 100 times better than my previous birth with OB's barely in the room and a terrible nurse who didn't help me one bit and in fact made matters difficult. She knew my fears, kept me off my back, gave me space for free movement, asked before she did things, and explained when she deviated from my desires. She respected me, and tried hard to read me.

See, I came into that birth with a wound from the previous one. Also with my own issues in that I was fixated on the previous problems. I think, if my midwife was annoyed with me, she didn't show it but could easily have been. I was having my 7th baby but was hyper controlling about a lot of things. She was caring, hugged me at prenatals, and stuck around and in the room during birth. She acted as midwife and doula both really. Some might call her a medwife because she used the fetal monitor, asked me to not vocalize when there was a long decel, and because she broke my water. However, looking at the situation, I had an OP baby with a tilted head. I pushed for 10 minutes, the midwife mentioned a tight cord had been around her neck later (at the 6 week). You know, had I been with a different provider, I may have had a different outcome, who knows? I'm happy with the care I received even if there were a few things I thought I would have done differently. I think everyone can pick apart a fabulous birth and find something that could have been tried to make it easier, different (well almost any birth). I am satisfied, and would use that midwife again given the chance. The difference between a midwife and OB to me? Availability. We had her actual beeper and she called back. Call anytime was her phrase. She stayed for the entire labor (except to go to the bathroom for 5 minutes and to call her hubby and let him know she was going to stay). She was there for me.

January 13, 2011 | Unregistered CommenterDawn

I have a Q Barb - I am a British midwife & don't understand all this CPM etc stuff means - please can you explain for your international readers? We only have Midwives in the UK, we are all equal, we all have the same qualification ratified & recognised by the Nursing & Midwifery Council. We also have our own Union - the Royal College of Midwives.

January 13, 2011 | Unregistered CommenterLiz

Medwife is nothing more than a slur, one often seen thrown at those in the profession with more experience/education than their peers. As long as this mentality exists, it continues to undermine midwifery as the profession it is or at least can be, not some hoodoo voodoo pasttime for alternative or hippie mommies.

Also, thank you for saying this... "not all women who choose midwives are looking for the “enlightened, spiritual” birth experience. " This is my first pregnancy and I've chosen a registered midwife for my care. I admitted this to ONE person at work who asked directly and it's apparently big time water cooler gossip. I've gotten many odd, (and actually a few rude) comments and questions along the lines of do I plan to chant my baby out at home and then eat my placenta. While it's cool with me if that's what floats your boat, I don't see why my seeking competent care from a highly trained professional that happens not to be an OB makes everyone conclude I am a incense burning, earth-Mama hippie. So THANK YOU for pointing out what should be obvious that there are all kinds of women who choose midwife care for all kinds of reasons because I'm getting tired of being painted with the same, well worn, brush!

January 14, 2011 | Unregistered CommenterLori

Liz: I am glad to. It'll be a different post. I did define it before, but it was seen in such a negative light (I compared CNM's to CPM's education requirements), I was strong-armed to remove it. I feel a tad more freedom now that I'm not going to do homebirth midwifery anymore, so, when I get my footing, you can bet I'll be addressing this issue again.

January 14, 2011 | Registered CommenterNavelgazing Midwife

This is a bit off topic, but in response to your comment that your "job" is to keep mom and baby alive, I just have a problem with that mentality. I don't understand how a provider could willingly accept responsibility for something that is ultimately not within their control in every case. There are situations in which the most skilled professionals cannot prevent a death, and there are risks and trade-offs that can't be fully anticipated. It is the patient who has to live with the consequences, and therefor the patient that has to weigh the risks/benefits in all but the most emergency time-sensitive situations. In the context of all the malpractice scare defensive medicine conversation, I just don't understand why health care providers want to be responsible for the outcomes. They are scared of being blamed when something goes wrong but then say things like it's my job to make sure you and your baby live- which certainly suggests that if either does not you didn't do your job (ie: did something wrong).

January 14, 2011 | Unregistered CommenterEmily

A lifeguard's job is to keep swimmers safe and alive if they get into trouble. A midwife is often compared to a lifeguard in birth.

You say, "I just have a problem with that mentality. I don't understand how a provider could willingly accept responsibility for something that is ultimately not within their control in every case. There are situations in which the most skilled professionals cannot prevent a death, and there are risks and trade-offs that can't be fully anticipated."

First, there's a collection of responses that goes with discussing your one paragraph quoted above. So, humor me as I go 'round and 'round, following the thoughts in my head. They aren't linear, so be forewarned.

- Many providers, especially midwives, don't feel we made a choice to be providers, but were called to be one. Therefore, a power greater than ourselves decided we were meant to be responsible for helping keep a mother and baby alive.

- My job is to HELP keep a mother and baby alive. I do not claim to have The Greatest Power In The World that can save all of humanity. But, in certain situations, I absolutely can -and have- kept a mother and baby alive when, had I (or someone who did what I did) not been there, they would, most certainly, have died.

- If part of my job isn't to keep a mother and baby alive, 1. Why have a midwife? 2. Why would I need to learn and re-certify my NRP every year? 3. Why learn how to do CPR? 4. How to stop a hemorrhage? How to resolve a shoulder dystocia? 5. and on and on and on regarding the multitude of skills and knowledge I've learned and continue learning over the years?

- If your purpose is to try and remove the arrogant midwife from thinking she has *any* control over the life of a mother and baby, you're not going to.

- If your purpose is to remind us that death can happen even in the best of situations, even with great medical or midwifery care, I'm pretty sure we already know that.

- If your purpose is to ask what sane person would possibly, on purpose, take on the task of trying to keep another human being alive (birthing family or otherwise), that's a question most care providers ask themselves every once in awhile, but are usually too busy to consider the inner drive that compels them to do so. Strangers that race to New Orleans or Haiti to save others, sometimes at the expense of their family time, their health and even their lives... caring for others, loving others and attending to others in their time of need is simply a basic human emotion. When a life is needlessly slipping away, it is almost instinctual to reach out to help.

As a midwife, the help I reach out with has been learned. That doesn't make me arrogant or believing I can save everyone. But it doesn't mean I'm going to just sit idly by watching a mom or baby die because I might not be able to save them. I will, as the saying goes, die trying.

January 14, 2011 | Registered CommenterNavelgazing Midwife

--If your purpose is to ask what sane person would possibly, on purpose, take on the task of trying to keep another human being alive (birthing family or otherwise), that's a question most care providers ask themselves every once in awhile, but are usually too busy to consider the inner drive that compels them to do so. Strangers that race to New Orleans or Haiti to save others, sometimes at the expense of their family time, their health and even their lives... caring for others, loving others and attending to others in their time of need is simply a basic human emotion. When a life is needlessly slipping away, it is almost instinctual to reach out to help. --

you know i worked in conflict zones doing what is considered first line humanitarian work. and i never thought of it as my job/role to save anyone's life. my job was to provide support for people (yes, in emergency life/death situations) to figure what was best for themselves and to save their own life. my job was to work in solidarity with folks.
and yeah i worked with people who did see themselves as more in a 'saviour' role but frankly i found them to be the least effective and most dangerous people to work with. it turns out that there is a lot of self centeredness in being a saviour.
and it shows. i mean you mention haiti and new orleans, which are two of the places in n america that have had a huge amount of money, aid, volunteers (with saviour roles), and where there has been the least amount of progress in terms of community building and empowerment. there is rioting in the streets in haiti because of the lack of progress and the fact that un workers started a cholera epidemic in haiti (which is the last thing haitians fucking needed...)
also when i worked as a human rts worker, i asked myself everyday -- why am i here? what am i doing? what is my role? what are my relationships with the people i am working with?
i think the fact that aid workers dont ask this question more often is why aid work is so ineffective. (and it should be said that aid work has never ever ever lifted a country out of poverty. instead aid organizations multiply in a given region, even though the populations dont see an increase in quality of life in anywhere near to the proportion of the multiplication of aid agencies...)
and i realized that i cared for others, loved them, attended to them as one human being to another. but i didnt save them. at most i held a bit of the space so that they could save themselves.
okay, i just wanted to break that down before applying the analogy to midwifery. but you can probably see where i am going with this...
when i witness birth i dont see it as my job to save anyone. really, i just dont. my job is to offer as accurate information and skills/manipulations (with her authentic consent) as possible to the mama. but its her choice, her birth, her life.
--It is the patient who has to live with the consequences, and therefor the patient that has to weigh the risks/benefits in all but the most emergency time-sensitive situations.-- yes. yes. yes.
i guess its because these emergency situations are rare, so i dont define a large part of my role during birth as one who acts in these emergency situations. you know? most of the time i am able to talk to the mama before the birth (during prenatals) and work out how she wants to me to act during certain very unlikely emergency circumstances.
but i am sure that there are mamas and families that really do want a saviour at their birth. and lucky for them there are plenty of midwives who are willing to fulfill that role.
oh and, i dont umderstand why people are getting offended at being called a medwife. just because some people use the term in a derogatory manner. maybe its just me. ive been called a radical plenty of times, sometimes in a positive manner, often times in a negative one. i dont personally consider myself a radical. just a girl with common sense and a mind of her own. but shrug if you call me radical, extreme etc.
i mean if you are all about following the standard medical protocols, im probably calling you a medwife. i just kind of think its funny, like all the kids who claim they arent hipsters, but rock skinny jeans, animal collective, plastic framed glasses, unwashed hair and fixies.
rather than fighting the term, why not embrace it? im sure that there are plenty of mamas and families who want nothing more than a medwife attending their birth.
but then i should add that i live in cairo. and the system of midwifery is difft here than in the states. so i work in a sphere of freedom that i am really grateful for.
anyways, i have stopped for the most part engaging in online convos with n american midwives cause it just wasnt relevant to what i am working through or where i am. but i did want to drop my lil 2 egyptian pounds (thats like 40 cents)...

January 16, 2011 | Unregistered Commentermai'a

It is so funny, Mai'a (not haha funny), that you see what I said as a Savior sort of comment and I see it as the most humble, honoring, sit quietly and watch in awe as birth unfolds unless I am needed to keep a mom and baby alive comment.

If I were in a country in crisis, I would *not* be thinking, "Da ta da!! Here I am to Save you from your crisis!" I feel exactly as you do, to offer my Self, in whatever capacity I am needed, to do what the *locals* said I needed to do.

This is not different than what I am asked to do in midwifery; I am doing what the mother has asked me to do... to be there in case she or the baby need help. I see nothing Savior-like in that. At. All.

I do, however, understand the Savior mentality because I have seen that. The arrogant I'm-the-Queen-of-Birth-and-I-Know-All attitude. I honestly (pray!) don't believe that is what I mean or do. I really hope not.

What's interesting is that as I move into Monitrice/Doula work, that role, even if it were a Savior thought, is removed.

Oh, a thought. Let's digress for a second.

I've heard a couple of times now that the ultimate responsibility for life and death is the person themselves. I understand that if you mean spiritually, but physically? Isn't that what the person hired a midwife to help her with? To be her (and her baby's) handmaiden should death come close and she be deep into her birth experience and need a hand? I don't understand how you can say it is ultimately her choice about her living and dying when she's *designed* her birth around the reality that death does come knocking at birth sometimes and, with minimal/maximum help at times, death is averted.

Case in point: For eons, when babies are born in some cultures, if the baby is in apnea (primary or secondary), the baby was considered a stillborn. The death rate of newborns was atrocious. Then, when the women were taught basic newborn resusitation... just their mouths and hands, no equipment... the stillbirth rate plummeted. Should we have not meddled and let all those babies die? Some (perhaps even you) might argue yes. But, just by having a tiny bit of new knowledge, hundreds of thousands of babies are "saved" every year.

http://www.iapindia.org/iap-resources/other-resources/iap-nrp/93/305

Hmmm... not sure where to go from here, so I'll wrap it up. You're a great converser, Mai'a. You offer a vantage point we rarely see here. Thank you for poking your head in.

January 16, 2011 | Registered CommenterNavelgazing Midwife

If the midwife is not there to keep mother and baby safe and well and ultimately alive, then what the hell is she there for?

To see your role as keeping mother and baby alive isn't to be a Saviour with a capital S, it's to be a professional healthcare provider. Because that's what healthcare providers do - they keep people in optimal health, and yes, living. Of course there is so, so much more that a midwife does, all of it very important, but if her priority is not keeping mother and baby alive, then she's not a very credible midwife.

January 16, 2011 | Unregistered CommenterHilary

Let's not forget that drugs and interventions aren't always contrary to one's Best Birth(tm). The pregnancy of my second child was managed, beautifully, by midwives; I had quite a lot of extra testing and ultrasounds and, ultimately, drugs and interventions in labor. They were not even vaguely "medwives," though I'm sure there are some who would slag them with that term. Let me catalog the interventions that supported my perfect birth:

- Tested me for gestational diabetes twice, due to my BMI and family history of diabetes. This was the impetus to get me onto a low carb diet, which probably helped prevent me from developing GDM.

- Performed a couple of growth ultrasounds late in my pregnancy. I lost 30+ pounds while I was pregnant, which resulted in some stagnant fundal measurements; the growth ultrasounds showed that the baby's growth was fine, which kept me in the low-risk category.

- Put me on terbutaline when I developed pre-term labor, contractions every 5 minutes for 4 hours that resulted in my cervix going from long, closed, thick, and firm to 75% effaced and 3cm dilated at 35 weeks. Without the terb, I might have gone into full-bore labor prior to 37 weeks.

- Performed an amniotomy when I was 6cm after my labor stopped, again. I had been in labor on and off for a month, it was a Sunday, we had converted to homebirth and prepared my bedroom for a birth suite, I had child care. Without the amniotomy, I might have gone into full-bore labor in a couple of hours, and I might have in a couple of days, but the chances that things would be so perfectly set up for a joyful relaxing birth were few.

Not all interventions are interferences with one's best birth. For my best friend, an enormous number of interventions -- including 3 prostaglandin gels and 22 hours of pitocin -- allowed her to avoid a C-section after pre-E developed at 38 weeks. It wasn't the birth she dreamed of, but being able to give birth to a healthy baby without abdominal surgery was a very positive and welcome outcome. I am a natural childbirth advocate, more than I thought I'd ever be, but it is one-sided and overly reductionist to claim that interventions are always interferences.

January 17, 2011 | Unregistered CommenterKathryn T.

Great discussion. I've thought about this some as I had a hospital CNM for my first birth and a CPM (though not licensed in my state) with my home birth. I am new doula and an aspiring OB.

To me, the difference between a midwife and a "medwife" is that which separates a lot of good baby catchers and .... those that are less so. The midwife (or good OB) will help mom make informed decisions about her care, will treat her respectfully and compassionately, and will help her achieve the birth she wants and has chosen, and, should unforeseen circumstances arise, will discuss with her what's going on in a non-scary way and will help her make decisions (or understand decisions that were made). Sometimes drugs are needed - or drugs are wanted. That does not a bad birth professional make.

Coming back to my own midwives - I love them both dearly. They were so kind and respectful. They helped me trust myself, my birth, and them. They informed me without pushing and they listened to me - fears and questions. If a medwife is defined by one who carries medication - I'm glad they did. I had a PP hemorrhage the first time and excessive bleeding the second. It's just the way my body births.

Thanks for the discussion, Barb.

January 18, 2011 | Unregistered CommenterMeg

MEDwife - Someone who works in a hospital (usually a CNM) and has TOO many patients.

A MEDwife *CANNOT* Midwife (be with woman) to support her because she has 12 - 35 other laboring women in the same ward.

What turns a CNM into a MEDwife? A steady paycheck and a willingness to lower the bar on what midwifery really means (to be with woman). A willingness to 'compromise' with the hospital by taking WAY too many patients - all the while knowing that she and her MEDwife partners cannot possibly midwife them all.


Can you tell I feel like my MEDwife lied to me??? If she had been HONEST and told me she couldn't possibly MIDWIFE me while in hospital I would have found another midwife that could have. I would have gotten a doula, I would have chosen a birth center. My MEDwife wasn't honest with me (isn't honest with a lot of women) about her ability to be able to be a true Midwife and be with that woman.

August 3, 2011 | Unregistered CommenterOubli

Medwife =pushes induction before 42 weeks because its policy and/or because it puts baby at risk

Doesn't know how to use a fetoscope, only doppler to hear babies heartbeat.

Uses black and blue cohash for "natural" induction.

Midwife= supports a woman in making her own educated choices

Stays as hands off as possible

Counsels women to be patient and allow their body and baby to work in their own time

Tells women they are strong and they can do it

May 20, 2012 | Unregistered Commenterjenbowers

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