I am please to share this guest post from Sera Bonds of Circle of Health International (COHI*). Sera wrote this in response to a NYTimes article the framed midwifery as a fad/status symbol.
While I am thrilled to see midwives covered in the NYT as something other than folk heroes, I disagree with specific elements of the characterization and want to provide readers with some facts on midwifery as a safe, practical, and age-old healthcare practice, as compared to a trend that we as women choose based on pop culture or emotion.
1. Midwifery is not a trend or a fad; it’s probably the oldest profession in the book.
Midwives? Not a trend. Midwives are truly the oldest profession in the world, not to be confused with prostitution, which I am pretty confident didn’t actually pop up until much later than women started supporting each other in childbirth. Women supporting each other in childbirth, is an old business, folks, I am talking seriously old here.
The Old Testament offers us the following Hebrew term translated “the midwife” (hameyaledet) that can be translated “the childbirth assisting woman.” This term occurs in the singular (“midwife”) three times: in Genesis 35:17, Genesis 38:28 and in Exodus 1:16. The plural form (“midwives”) occurs at least seven times, and all in the first chapter of the book of Exodus. I am not sure I would consider the Old Testament trendy, but I do believe they were on to something.
2. Midwifery is not just for “crunchy types” – it’s the leading form of health care for pregnant women in some of the most developed countries around the world.
Midwives around the world are the lead and primary health care providers for pregnant women. This includes women delivering in villages and huts, and it includes women delivering in high tech hospitals and birth centers all over the world. Midwives are trained in healthy birth, and how to identify risky pregnancies through thorough prenatal care and screening. When this model works, women’s and babies’ lives are saved, ensuring that the 15% of the population that needs emergency care gets it in a timely manner.
In many of the more developed places where midwives are the primary health care providers for pregnant women, we are on average talking about moms who are educated, professional, and have access to information, insurance, and the provider of their choice. The key difference between us and them? They are very likely covered by a socialized health care system.
Another perk that women in most socialized countries benefit from is the post-deliver home visit. This goes a long way in saving socialized systems from paying out for mental health as this can easily be assessed in a home setting where it can easily be missed in a clinical setting. Other things that can be observed during home visits are hygiene, drug addiction, and domestic violence. All public health causes that the US has yet to champion.
3. The main reason you may have so much trouble getting into a midwifery practice has less to do with the quality of care they provide or its “elite” status and more to do with the profit-driven nature of the American health care system.
The primary differences between physicians and midwives in the US are cost and the model of care being offered. Health care in the US being a for-profit venture places us, women of reproductive age, in a powerful position. The impact of the US dollar is no small threat, or promise, and as consumers of pregnancy and labor care, it is up to us to decide what model we want. If we were to lobby with our dollars for midwifery care, we would find it poking up in far from trendy places like middle America and even, I dare say, in red states. As long, however, as the profit margin rests with the physicians then this is the model of care that will continue to reign supreme.
What an article like this one hopefully does for women and midwives is raise the profile of this midwife-provided care as an option to pregnant women, and the need, around the world, for more midwives. A recent report from the World Health Organizations provides new information and data gathered from 58 countries in all regions of the world. Its analysis confirms that the world lacks some 350,000 skilled midwives — 112,000 in the neediest 38 countries surveyed — to fully meet the needs of women around the world.
If boutique midwifery clinics in Park Slope and Manhattan are what it takes in the US for midwifery to become a profession that people choose to pursue and that we as mothers choose to support as consumers, then more power to this trend. But if this is not what happens and midwifery in the US continues to be available only in upwardly mobile urban centers and the more rural and organic thinking communities then many women who would greatly benefit from a powerfully, transforming, and intervention-free birth, which is what midwives excel at doing.
4. Midwives can help mothers give birth to healthy babies, but no one can promise a perfect delivery from start to finish
Lastly, one myth of the midwife that I would like to dispute that is asserted by the author is that midwives offer control to the delivering woman. In the US, those of us who come from power and privilege often assert this during our interactions with our health care providers. Choosing to use a midwife for your delivery does not, for all of the positive attributes to this model of care, guarantee us the happy, empowered birth we dream of. That responsibility lies with us, and only us. One of the sad outcomes of increased use of midwives, and this is not to be attributed to midwives, is the dogma surrounding the “right” way to be pregnant, to delivery, to feed, and to raise up our kids. Shame on us as consumers for the disengagement we afford ourselves and the pressure we place on midwives to deliver the birth we want. In birth, as in life, it is equal parts preparation and luck. You get what the birth fairy brings you, and it is the job of whoever is providing your health care to ensure that you are informed, advocated for, and safe.
*COHI is currently participating in Amplify Austin, a 24 hour event geared toward raising money for non-profits in Austin, TX.
Sera Bonds is a social justice, grassroots activist committed to working towards balancing the scales of access, equity, and availability in women’s reproductive health care. She has training in massage therapy, midwifery, a Bachelor of Arts degree in Women’s Studies, and a Master’s degree in Public Health. Her community organizing background ranges from reproductive rights to violence against women, to welfare and poverty issues to anti-war campaigns. She has worked on women’s health issues with teenage and minority mothers in rural areas of the Western U.S.; with refugee communities in Boston, Massachusetts; and with midwives in Northern India, Guatemala, Tibet, Palestine, tsunami-affected Sri Lanka, Sudan, Tanzania, Haiti, and Israel; with commercial sex workers on issues of HIV/AIDS in Vietnam; and with female evacuees from hurricanes Rita and Katrina in Louisiana. She founded Circle of Health International, as U.S.-based NGO, with the hope of giving voice to conflict- and disaster-affected women’s reproductive health needs on an international scale. Sera served as a visiting lecturer and Public Health Scholar-In-Residence at Ben Gurion University in Beer Sheva, Israel, an International Reproductive Health Fellow at NARAL-Texas, and was selected as a recipient of Boston University’s School of Public Health’s Distinguished Alumni Award. She currently lives in South Austin, Texas, working for a U.S. abortion advocacy organization focusing on increasing access in the Southern U.S., and lives with her husband, two toddler age sons, and loves every minute of it.