Midwifery

Midwifery is the practice of assisting in the birth of a child and the care of an expectant parent. One who performs midwifery is called a midwife. Midwives provide care and support for the mother or birthing parent before they have the child, help with the delivery of the child, and aid the mother or birthing parent in caring for the newborn and themselves through the postpartum time. They provide instructions for breastfeeding and sometimes come to the home to answer questions and coach the new parents.

Midwives can and do provide medical care, including gynecology. Modern midwives provide diagnostic tests, assist expectant parents in formulating proper diets, and may work at birth clinics, in hospitals, and in patients' homes. Thus, their role spans both medical and emotional support for those who enlist their aid. Midwives often provide mothers and birthing parents with births in the security of their own homes, as many people would rather be in a safe, comfortable environment than a busy hospital filled with patients.

Background

In colonial times, few doctors practiced medicine. Many of the available European doctors were not educated. Initially, midwives in England were given priority to board ships to the New World. The services midwives provided were in demand, as men were not customarily present during childbirth. It was deemed improper for men to witness birthing. Childbirth was a fear-inducing experience, and many women dreaded the real possibility of death. Indigenous groups also often had midwives among their members.

A pervasive myth about early midwives is that they were often accused of witchcraft. This is not true. Midwives had to maintain a trustworthy reputation within their communities. Although it is possible that midwives may have been accused or convicted of witchcraft at one time or another, this was an uncommon occurrence.

Just before the nineteenth century, hospitals and doctors were more prevalent than midwives. Many believed midwives were incompetent and lacked the medical knowledge to oversee births. The difference between standard medical practice and the naturopathic methods employed by midwives was quite pronounced.

During the nineteenth century, more people began to believe that a woman's role was inside the home. This belief resulted in even fewer midwives. The sentiment also led to low pay for midwives, as many did not consider their work to be a real profession. By the end of the nineteenth century, those who could not afford doctors sought the help of midwives. Physicians at this time, however, had statistically higher success rates than midwives.

In the twentieth century, more doctors were educated. Doctors received more formal education than midwives did, which further strengthened the belief that midwives did not have the proper knowledge to attend to pregnant women and infants. Furthermore, hospitals offered methods that eased or eliminated the pains of childbirth, which made them a far more attractive option than hiring a midwife.

Professional midwifery emerged as the twentieth century continued. Midwives obtained formal medical education and certifications; at the same time, midwives of color were actively excluded from formal training opportunities and were barred from practicing by new laws and regulations.

The 1970s brought about additional changes. Some people wanted a less institutionalized childbirth. Women wanted to learn to care for themselves. However, home birth was vigorously discouraged by the American Congress of Obstetricians and Gynecologists (ACOG), and a doctor who assisted in a home birth could face disciplinary action, including being fired.

In the 1990s, some insurance companies required higher premiums for, or simply refused to insure, doctors who worked with midwives. A federal law enacted in 1994, however, required Medicaid to pay for certified nurse-midwives.

Overview

The term “midwife” may refer to a certified professional midwife, a certified midwife, or a certified nurse-midwife (CNM). Both CNMs and certified midwives hold advanced nursing degrees, with the primary difference being whether they are licensed in nursing. By contrast, a certified professional midwife trains through apprenticeship and cannot practice in a hospital. Midwives who work in a hospital may be required to submit to the oversight of an obstetrician-gynecologist (OBGYN).

The credentials needed to practice midwifery vary by location. By the early 2020s, two-thirds of the states and Washington, DC, had regulations governing midwife-assisted home births, though it remained a legal gray area in states without formal licensure. That year, Hawaii restricted the practice such that it excluded many traditionally trained Native Hawaiian midwives, leading to a lawsuit in 2024.

Midwives remain a popular option for childbirth as of the early twenty-first century. In 2021, certified nurse-midwives or certified midwives assisted with 10.7 percent of births in the United States, according to the National Center for Health Statistics. Midwives are recommended for low-risk pregnancies, as the midwife birthing process involves few medical treatments.

People often go to midwives because they want to give birth at home. The number of people giving birth at home has risen steadily during the first decades of the twenty-first century. In 2021, more than fifty thousand home births took place in the US, the highest number in three decades. Home births made up 1.4 percent of all US births. Likewise, during this period, the US has seen an increase in the use of midwives who are qualified to attend to home births. The surge in home births has been attributed to several factors, including the COVID-19 pandemic and the closure of labor and delivery units in many hospitals. Nonetheless, infant mortality remained twice as high among home births than hospital births, according to a 2023 Washington Post analysis of CDC data.

People may choose a midwife for other reasons. Some do not want to give birth in the institutional and antiseptic environment of a hospital. Some think the attendants in hospitals can be impatient or cold. Parents of color may fear outright mistreatment by providers due to systemic racism; indeed, maternal mortality rates remained far higher for Black women than White women. Some people are averse to having an entire team of medical professionals prodding them with fingers or tools, while others are uncomfortable with medical interns spectating the birthing process. A person may desire control over who can witness the birth of their child and may prefer not to have an audience of strangers.

Midwives are supposed to be respectful when a person refuses a procedure. They educate expectant parents about various procedures and answer whatever questions they may have.

Midwives have several responsibilities, according to the American College of Nurse-Midwives (ACNM). Throughout the pregnancy, midwives must provide exams. They need to guide the mother or birthing parent through decisions, such as what to do when complications arise and whether to use anesthesia. When the child is born, the midwife should give the parents information and recommendations for dealing with colic. The midwife should help the mother or couple adjust to life changes that an infant brings. Midwives also educate people about breastfeeding.

The World Health Organization endorsed midwifery in 2016, stating that studies suggest that comprehensive midwife care (including family planning services) could prevent 83 percent of all maternal deaths, stillbirths, and newborn deaths. Research has also correlated midwife-led care with other positive health outcomes, such as fewer medical interventions during labor, fewer C-sections, fewer premature births, and higher birth weights.

Doulas have some similarities to midwives, but they are not midwives. They provide emotional support but do not actually deliver the child. They educate expectant parents on what will happen throughout pregnancy and during labor and delivery. Doulas may sometimes fetch items a mother or birthing parent needs or provide rides for them. Doulas do not provide medical care. Like midwives, they provide breastfeeding education. They may assist with the infant's needs. They can fill the role of maid or housekeeper after the child is born, handling household tasks so that the new parents can rest. Some of these tasks may include making meals or snacks. Like midwives, doulas help the family adjust to the addition of an infant. Doula services are often not covered by insurance providers, though.

Bibliography

“Breastfeeding Support.” The Midwife Center, midwifecenter.org/services/breastfeeding-support/. Accessed 8 Feb. 2017.

Brittain, Amy. “A Maryland Home Birth Midwife with a Felony Record Faces Scrutiny after a Baby Dies.” The Washington Post, 14 Nov. 2023, www.washingtonpost.com/investigations/interactive/2023/home-birth-midwife-karen-carr/. Accessed 5 Mar. 2024.

“The Case for Midwifery.” World Health Organization, 2016, www.who.int/maternal‗child‗adolescent/topics/quality-of-care/midwifery/case-for-midwifery/en/. Accessed 18 Sept. 2018.

Cohen, Marisa. “Nurses vs. Doulas vs. Midwives: Who's Who.” Fit Pregnancy, www.fitpregnancy.com/pregnancy/labor-delivery/nurses-vs-doulas-vs-midwives-whos-who. Accessed 8 Feb. 2017.

“Differences between a Doula and a Midwife.” All Nursing Schools, www.allnursingschools.com/articles/doula/. Accessed 8 Feb. 2017.

Feldhusen, Adrian E. “The History of Midwifery and Childbirth in America: A Time Line.” Midwifery Today,2000, www.midwiferytoday.com/articles/timeline.asp. Accessed 8 Feb. 2017.

Gregory, Elizabeth, et al. “Changes in Home Births by Race and Hispanic Origin and State of Residence of Mother: United States, 2019-2020 and 2020-2021.” National Vital Statistics Reports, vol. 71, no. 8, 2022, www.cdc.gov/nchs/data/nvsr/nvsr71/nvsr71-08.pdf. Accessed 4 Mar. 2024.

Harley, David. “Historians as Demonologists: The Myth of the Midwife-Witch.” Social History of Medicine, vol. 3, no. 1, 1 Apr. 1990, pp. 1–26, academic.oup.com/shm/article-abstract/3/1/1/1689119/Historians-as-Demonologists-The-Myth-of-the. Accessed 8 Feb. 2017.

“Homebirth and Community Midwifery.” Midwives Alliance North America, mana.org/about-midwives/homebirth. Accessed 8 Feb. 2017.

Krebs, Natalie. “As Home Births Rise in Popularity, Some Midwives Operate in a Legal Gray Area.” NPR, 5 Apr. 2022, www.npr.org/sections/health-shots/2022/04/05/1089927028/midwives-home-births. Accessed 11 Apr. 2022.

McCracken, Leilah. “A Declaration of the Rights of Childbearing Women.” Midwifery Today, 1999, www.midwiferytoday.com/articles/declaration.asp. Accessed 8 Feb. 2017.

Miller, Jennifer. “Midwives Are Still the Exception in the US. New Startups Are Trying to Change That.” The Guardian, 8 Nov. 2023, www.theguardian.com/society/2023/nov/08/midwife-startups-obgyn-pregnancy-birth-oula. Accessed 5 Mar. 2024.

Mulder, Tara. “Midwifery, Then and Now.” Eidolon, 16 Dec. 2016, eidolon.pub/midwifery-then-and-now-7c3447b84675. Accessed 18 Sept. 2018.

Nayak, Anika. “The History That Explains Today’s Shortage of Black Midwives.” Time, 29 Feb. 2024, time.com/6727306/black-midwife-shortage-history/. Accessed 4 Mar. 2024.

Osterman, Michelle, et al. “Births: Final Data for 2021.” National Vital Statistics Reports, vol. 72, no. 1, Jan. 2023, www.cdc.gov/nchs/data/nvsr/nvsr72/nvsr72-01.pdf. Accessed 4 Mar. 2024.

“Parkland School of Nurse Midwifery: History of Midwifery in the US.” Parkland Memorial Hospital, www.neonatology.org/pdf/midwifery.history.pdf. Accessed 8 Feb. 2017.

Sherman, Carter. “‘The Model Is Not Working’: US Midwives Navigate Legal Limbo as They Save Lives.” The Guardian, The Guardian, 28 Sept. 2023, www.theguardian.com/society/2023/sep/28/midwives-law-with-woman-documentary. Accessed 4 Mar. 2024.

“What Is a Midwife?” Midwives Alliance North America, mana.org/about-midwives/what-is-a-midwife. Accessed 8 Feb. 2017.