Editorial: A Knowledge Base Fit for All Midwives

by Jan Tritten

© 2004 Midwifery Today, Inc. All rights reserved.

[Editor's note: This editorial first appeared in Midwifery Today Issue 69, Spring 2004.]

The question we must ask ourselves is this: Can a midwife survive a medicalized education and still come out an authentic midwife? One who knows the difference between lifesaving, necessary procedures and rituals, many of which are dangerous to the motherbaby? In a time of increasing cesarean sections and intervention rates as high as 99 percent in some hospitals, this is a question we must ask ourselves for the sake of society.

If we look at what is happening in hospital birth, the evidence shows that nearly all women should have a midwife with continuity of care and have their babies at home if circumstances stay within a normal range. We might need 100,000–200,000 new midwives.

Medicalization is very seductive and clandestinely so. I know midwives who began as lay midwives, got their CNM training and slowly became indoctrinated into the medicalization of their practices. They are like the proverbial frog in a pot of warm water on the stove; the heat is slowly turned up and the frog stays put, not realizing until too late that it is being boiled. I also know many nurse-midwives who have survived the indoctrination and can tell the truth from the myths, but it is a daily battle.

More evidence to support midwifery knowledge exists than ever before and yet we, all types of midwives, keep adding more and more unnecessary practices and protocols to our work. We can look to Michel Odent's work and ask the question he asks: "What do women in labor really need?" We know his answer. In brief, women need to be undisturbed to allow their hormones to function fully for the birth process; they need to be undisturbed by our routines so they can bond with their babies.

Michel explains that oxytocin is highest just after birth, if the mother has not received drugs, all of which block her own oxytocin. The woman's oxytocin is the mothering hormone. The new mother is flooded with it for the first hour after birth for the purpose of meeting and bonding with her baby. Disturbing the mother in labor and just after birth also disturbs her oxytocin level. Yet here we are talking, asking questions, giving shots and looking at machines. The mystery is that anyone can give birth and bond in this situation. The reality is that many do not.

So, what do we need to know to be good, protective, life-saving authentic midwives? Traditional midwives serving traditional societies do not have the same knowledge base that we do. Many have great statistics especially when dealing with healthy, well-fed women. What is their knowledge base? Of course, it varies from culture to culture and person to person. What can we learn from them and visa versa? Many years ago I worked on the NARM test with 15 other midwives. We were taking the test to see how biased it was. I turned to Sandra, a midwife who works regularly in Senegal, and said, "Well, at least it is a culturally sensitive test." She said, "No it isn't." That's when I realized that the test nails down the westernized cultural view of what one needs to know to be a midwife.

Robbie Davis-Floyd told me about a fascinating incident she experienced in looking over the NARM test given to very experienced traditional midwives, all of whom failed. She asked one traditional midwife about her experience taking the test. The midwife said when they asked about hemorrhage, "I thought of every hemorrhage I had ever experienced to answer the question." Needless to say the midwife got through very little of the test. She needed to go over every birth to decide why the hemorrhage was happening as well as the cure. She would apply different techniques to control the hemorrhage depending on the cause.

All of this makes me wonder if we can come up with a base of knowledge that we really need to have for the sake of women and babies, not necessarily to fit into hospital or medical routines or even to combat them, but to really serve women.

I created this graphic to show how our basic midwifery knowledge systems differ.

These are difficult questions and concepts, but putting together a midwifery body of knowledge gives us something of a road map to the future of midwifery. We need to quit being Florence Nightingale, serving doctors and medicine. We need to realize that we are serving women, their babies and families, our society and God. If it looks no different than the myth-based, damaging knowledge and practice of obstetrics, then it is not midwifery. We need to begin pointing out that the emperor is naked.

As midwives and student midwives, we must reclaim our right to an authentic, accurate and changing body of midwifery knowledge. Changing because we are learning new insights all the time. Midwifery is a different profession than obstetrics; one dedicated to authenticity, with what should be all medical professions' foundation—to "first do no harm."

Toward Better Birth,
 jan

Jan Tritten Jan Tritten is the founder and editor-in-chief of Midwifery Today magazine. She became a midwife in 1977 after the wonderful homebirth of one of her daughters. Her mission is to make loving midwifery care the norm for birthing women and their babies throughout the world. Meet Jan at our conferences around the world! [ PHOTO BY ANDREA NOLL ]   >  Editorials  Click here to read some of Jan's Midwifery Today editorials.   >  Curriculum Vitae  1947 Born in Los Angeles, California. 1965 Graduated from Placer High School in Auburn, California. 1966 Trained for one year as a psychiatric technician. Courses included basic nursing, pharmacology, microbiology, anatomy and physiology, psychology. 1966–1971 Worked at DeWitt State Hospital in Auburn, California as a psychiatric technician. 1968 Graduated from Sierra College with an Associate of Arts degree. 1970 Graduated with honors from Sacramento State College with a Bachelor of Arts degree in Social Science. 1971 Earned Lifetime California teaching credential with fifth-year program from Sacramento State College. 1972 First daughter born in a hospital. It changed my life forever. It was an unsatisfactory birth experience, but I had a wonderful postpartum experience with 2-1/2 years of breastfeeding. 1976 Second daughter born. She was born at home with a doctor who talked me into a homebirth. The difference between the two births sent me on a path to do something to help women have positive birth experiences. 1976 Began training as a midwife. Because I was raising young children and running a business, and because there were no CNM schools in my area, becoming a CNM was not within my reach. 1977 Began attending births with the Birth Co-op in Eugene while organizing courses in our community taught by CNMs, physicians, nutritionists, etc. 1978 Began a midwifery practice, New Life Care, with a partner, Chris Howard, and apprentice Monika Dunsmore. 1979 Son born at home. 1980 Did a one-year program with Marion Toepke McLean, CNM. Four of us completed the program, which was modeled after CNM curriculum at that time. She took a year off from her practice to teach us and to go to our births with us. 1982 First group of midwives certified by the Oregon Midwives Council. Our board was composed of CNMs and physicians. 1986 Slowed down practice and started Midwifery Today magazine.

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