Midwives Matter
Today is International Day of the Midwife.
In Australia, mothers are supported by midwives during labour, birth and the postnatal period. Many women are also in the care of midwives during pregnancy. While we take this arrangement for granted, in countries like the US, midwives are not on staff in hospitals and mothers may not experience this traditional care model.
Midwifery is probably the oldest professional role of women and one which has existed since prehistory. Humans are one of just a couple of species who birth with support (along with bonobos and elephants) and the only species who actively participate in delivering the babies of another woman. Evolution has not been kind to the human female, with the large brain needed for our intelligence not having a correspondingly larger birth canal! The birth process can be long and arduous, with the most critical stage occurring when the mother is most spent. Midwives support and encourage the mother and guide the newborn into the world.
However it is the days following childbirth when these traditionally wise women really come into their own. The newborn human is so immature compared to other mammal species and instincts alone are not always enough to establish breastfeeding. Until very recent history it was the midwife who would be by the mother’s side in the days after birth, supporting her at every breastfeed if needed. Her whole focus would be the care of the new mother and baby.
When the medicalisation of childbirth took mothers out of the home and into institutions, the role of midwives became more like nursing. With the focus on cleanliness and routines favoured by the late Victorian era and in the early decades of the 20th century, more and more was expected of midwives beyond their primary role. Administration of rules and regulations, instruction of the new “mothercraft” and a strict hierarchy within the nursing model made famous by Florence Nightingale all impacted how midwifery was practised within hospitals. Two world wars, a global depression and a post war baby boom, alongside the introduction of infant formula products and marketing all influenced the change. Mid-century saw women being sedated during childbirth to the point they were not actively involved in the birth of their infant. Increased intervention in the form of forceps and surgery meant increasingly midwives performed nursing care in the postnatal period. From drugs used in labour to routine use of IV fluids and foetal monitoring, midwifery moved from a supportive model to one of management in just a century.
Women in the first decades of the 21st century have different expectations of the birth experience to their grandmothers and great grandmothers. While medical interventions have certainly reduced the risk of maternal and infant deaths in many parts of the world, that has come at some cost. Today mothers are swiftly discharged from hospital within days or even hours after birthing but not always with continuity of care. Domiciliary midwifery visits to the home can be limited or non-existent. The roll-over of care from midwives to maternal and child health nurses in the community is too often interrupted by delays. There are not enough nurses at any stage to enable the most optimal care and overwhelmed and unsupported midwives leave the profession they were once passionate about.
Mothers need midwives. Babies need midwives. Skilled, supportive and knowledgeable practitioners who have the time needed to guide a woman to birth and breastfeed in an unrushed and respectful manner. Midwives need to be experts in breastfeeding as well as pregnancy and birth. This education must come without the influence of infant formula marketing and should ideally be at the level of IBCLC lactation consultant expertise. Yet in some midwifery courses, breastfeeding is no longer a required subject!
The midwife was once the most respected woman in the community, on-call for every mother needing her skills. They still deserve such respect.
