Midwifery Model of Care—Phase II: Embracing the Unknowns of Birth
by Colleen Bak

[Editor's note: This article first appeared in Midwifery Today Issue 80, Winter 2006.]

Birth is an everyday miracle. Birth is studied endlessly by professionals and yet aspects of it remain characterized by unknowns and variances. Birth is continuously documented and written about and yet it maintains a shroud of mystery. Birth is indeed a paradoxical passion. Perhaps that is part of what draws so many of us to it—the nameless qualities that linger long after the physical experience of giving birth or supporting a woman through the process. In fact, accepting the unknowns of birth, while allowing for the unpredictability inherent in the very nature of the act and flowing with it is a defining tenet of the midwifery model of care. This very concept of trusting that not everything in birth can be logically deduced from tests or observation brings midwifery to its characteristic belief in the innate knowledge of motherbaby and in the use of intuitive tools.

The belief in the motherbaby dyad is a concept at the heart of traditional midwifery care. The social construction in modern medical birth that one specialist must be present for the birthing woman (the obstetrician) and an altogether separate specialist must be present for the baby upon birth (pediatrician/neonatologist) forces an artificial sense of separation onto the newly birthed baby and mother. This artificial conceptual separation aids in the process of applying typical hospital policies and procedures that result in the physical separation of mother and baby—performing newborn exams immediately and separate from mother, removing baby to a warmer or nursery for any period of time, etc.

On the other hand, in traditional midwifery care the midwife is the only specialist present to offer care for the motherbaby dyad as a whole. This care is provided in a manner that specifically respects the connection and need of mother and baby to remain together during this highly sensitized post-birth period—newborn exams are done in mother's arms, weight/measurements are delayed, motherbaby is honored as a whole with general avoidance of needless separation. Regardless of the twists and turns taken by a particular birth process nothing remains more touching than the sight of an undisturbed motherbaby embracing each other in a postpartum circle of love, with their innate needs fulfilled.

Belief and respect in the sanctity of the motherbaby dyad naturally and logically lead midwifery to embrace the intimate interplay that exists between mother and baby during pregnancy, labor and birth. This characteristic is unique to the tradition of midwifery. The idea that certain aspects of birth cannot always be known through clinical skills, tests or skilled observation is completely foreign to the medical model of birth. The midwifery model alone holds the tradition of respecting the mother's inner knowing, intuition and inborn bond regarding her baby.

The process of accepting this aspect of the midwifery model of care, even for the most dedicated of midwives, can truthfully be an intimidating and disempowering process. The idea that one will not necessarily be able to recognize exactly what is happening in birth or that sometimes the mother's feelings are more accurate than clinical tests can be frightening and a true challenge to embrace in practice, regardless of theoretical acceptance. In reality many factors serve as obstacles to individual midwives putting these ideals into practice. The risk of malpractice suits and legal action if the birth does not conclude in a way that parents find satisfactory looms over all practice considerations. But more often, the anticipated disapproval of back-up facilities or physicians can mitigate the full application of the midwifery model of care. Thus, one of the most apparent impediments to the practice of the authentic midwifery model of care is the passive control of midwives by the mainstream medical institution.

How can midwifery overcome these hindrances and return full-circle to its roots in the ability to embrace and trust the unknowns of birth? Unfortunately no simply implemented solution is available. The grand-scale approach would involve a full-spectrum health care acceptance of midwifery, along with the development of a true working partnership between obstetricians and midwives. This already exists in certain countries, while it remains a distant goal in others. Beyond the status of midwifery within the larger health care system, each individual midwife must accept a personal challenge to examine and reflect on her feelings about the unknowns of birth within her own practice style. How do you feel on an emotional level about those unpredictable aspects of birth beyond your control? On what level are you able to carry your beliefs over into your midwifery practice? What is aiding you in or impeding you from doing this? What actions can you take as an individual to help you to feel more supported in fulfilling this aspect of the midwifery model of care in your practice?

Sometimes the inspiration needed to follow in this ideal of the midwifery model lies in regular reflection on past experience and on the ways you or others have already naturally incorporated that ideal in practice. Those times when a home labor stalled and you tried all the techniques and tricks implicated by what you were observing, only to transfer, whereupon a beautiful birth unfolded to reveal a baby with enough meconium present to necessitate the hospital environment. Those times when clinical signs indicate that birth is imminent, yet suddenly the mood shifts and contractions slow allowing the woman and baby to rest and regain strength to tolerate the challenges of what turns out to be a lengthy second stage. Those times when diagnostic tests come up negative, mother is measuring perfectly, fetal heart tones are good and all signs point to normal progression, yet mom just cannot shake the feeling that something is not right and honoring this leads to more invasive testing that reveals an otherwise undiagnosable complication. Those times when a birth results in a less-than-perfectly responsive baby and the mother's voice and calming reassuring words, calling her baby to her, helped the baby to unfold fully into independent existence. Each of these situations requires the midwife to take a step beyond clinical observance or action to acknowledge and put her trust in variances within the birth process, the mother's innate body knowledge, the mother's intuition and connection with her baby and the baby's chosen path. This task is not simple and often requires personal reflection along with a set intention.

Another approach to reconciling your relationship with the unknowns of birth is by taking active steps to increase your personal intuitive skills. Anne Frye notes that by embracing and enhancing the intuitive skills that you as a midwife bring to a birth, you are simply adding to skills you have to rely on in any given situation you are facing.

One more way for members of the midwifery community to address the challenge of welcoming the unknowns of birth would be to actively immerse themselves in the same suggestions often given to clients to elicit a sense of trust in the birth process. By nature, midwives trust birth. However one can intellectually accept this while still finding challenges to fully incorporating this belief into a midwifery practice. For this reason taking proactive steps toward building or strengthening one's conceptual belief and trust in birth can never hurt. For instance, a midwife could make a point of regularly viewing beautiful videos of natural empowering births. Even if you regularly participate in this kind of birth in your practice, there is something about being able to take in and absorb the imagery in the total absence of clinical or emotional responsibility. It speaks directly to an older part of the brain than does reading or having an intellectual discussion about birth. In this way the innate beauty and power of natural undisturbed birth can become ingrained in the visual stores of your subconscious, remaining as a reserve for possible moments of doubt or worry.

Reading positive birth stories also can help to ingrain the message of trusting birth although it should complement and not replace entirely the visual component. Nonetheless, a wealth of inspirational birth stories is available in book compilations (such as Ina May Gaskin's Spiritual Midwifery and Ina May's Guide to Childbirth and Sheri Menelli's Journey into Motherhood) as well as on Web sites. Reading lovingly recounted stories of birth not only imparts a subconscious message of trust over time but also serves as a reminder of the positive impact midwives have on growing families.

Affirmations also can be powerful tools. Simply alter those used with clients to a midwife's perspective. For example: Women are the product of millions of years of successful childbirth, Babies know how and when to be born, I accept and embrace the mysteries and unknowns of the labor/birth process… One could simply pick a few affirmations that particularly resonate, alter them to fit a midwifery perspective, write them on cards and read them before bed or put them around your living area or in your birth bag where they will periodically catch your eye. The idea is to create your own culture of trust in birth and to immerse yourself in it. This not only will aid you in achieving authenticity within the midwifery model of care but also will envelop clients and further guide them toward your perspective and a fuller sense of trust in birth. If a midwife can free herself of extraneous worries about the unknowns of birth and come to embrace and love them as an interwoven part of the process, then her own intuition will be clearer and one more obstacle will be removed from the path toward using the knowing of the motherbaby as a natural tool.

Trusting in birth and embracing its unknowns, following your intuition as a midwife, listening to the deep knowledge created within the motherbaby dyad. These are all components of authentic midwifery within the traditional midwifery model of care. The modern climate of practice poses many challenges to fulfilling these aspects of midwifery care, but as midwives you still hold the power to take an active approach toward preserving and growing these aspects of your practice. Please take a moment to reflect on your own practice and your midwifery ideals. To whatever extent you are individually able, set yourself a goal to take steps, even small ones, toward reviving, reinventing or reclaiming your passion for the mystery qualities of birth. Embrace the unknowns.

Colleen Bak, MA, CD (DONA), has a BA in anthropology from NYU. She also earned her Masters in their Gallatin program, concentrating on modern birth politics in the US with a focus on the homebirth movement and the legality of midwifery. She currently works as a doula and is an active member of the board of directors of Friends of the Birth Center, a nonprofit organization dedicated to aiding in the establishment of an independent birth center in Manhattan. She is the mother of one daughter, lovingly born at home into the hands of midwives, and is currently expecting her second child. For more information on Colleen please visit www.fullmoonbelly.com or www.friendsofthebirthcenter.org.

Sources:

  • Frye, A. 2004. Holistic Midwifery Vol. II: Care during Labor and Birth. Chelsea, Michigan: Labrys Press.
  • Gaskin, I.M. 2003. Ina May's Guide to Childbirth. New York: Bantam Books.
  • Gaskin, I.M. 2002. Spiritual Midwifery. 4th ed. Summertown, Tennessee: The Book Publishing Co.
  • Kunz, D., ed. 1995. Spiritual Healing. Wheaton, Illinois: The Theosophical Publishing House.
  • Menelli, S. 2005. Journey into Motherhood. Encinitas, California: White Heart Publishing.

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