“Midwife,” Not “TBA”
At Midwifery Today we do not use the term “Traditional Birth Attendant,” or “TBA.” We believe it should be banned because it is derogatory and elitist, and was born of medical imperialism that spread to many parts of the world. As western-trained medical professionals, midwives, nurses and doctors travelled around the world in a possible effort to stem maternal and child death, they brought with them the arrogance and ignorance that their way was better whether statistics proved it or not. They blamed traditional midwives who were strong and respected in their communities for the bad outcomes, when often lack of food, clean water, sanitation and poverty were the causes.
After the end of the war with Japan, American nurses went and destroyed the Japanese system of birth houses, which probably had much better outcomes than hospitals in the US. There is an attitude of “our way is better than your way.” This arrogance has removed the title of midwife from real community midwives. This language got into each country’s nomenclature because the ones pushing for it had forcefully made the inroads towards ruining physiological birth everywhere! Remember, western practitioners were the ones who carried lithotomy position, episiotomy, artificial rupture of membranes, cutting cords short and a myriad of other horrendous non-evidence-based interventions abroad. These were the people who had the audacity to steal the term midwife from the midwives.
No one owns the word midwife or its equivalent in any tongue. If you practice midwifery, you are a midwife—not a TBA—a term assigned by a hierarchical system. The term midwife in any language carries with it love and respect to the community in which the midwife practices. It is past time to give that back. It is stolen property, stolen from those who cared for their community for thousands of years; stolen by a system that cuts more than 35% of babies from mothers in many countries, and many more in others. The term midwife crosses cultures and languages and belongs to all midwives. As the people from the Occupy movement are saying: It is time to take back our world!
Toward Better Birth,
— Jan Tritten, mother of Midwifery Today
Jan Tritten is the founder, editor-in-chief and mother of Midwifery Today magazine. She became a midwife in 1977 after the amazing homebirth of her second daughter. 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, or join her online, as she works to transform birth practices around the world.
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News and Research
A Finnish study has found that “low birth weight and slow growth in pre-adolescence significantly increases the risk of poor physical functioning at age 60.” Scientists studied almost 2,000 people over the age of 60 and hypothesized that the correlations between low birth weight and decreased physical abilities may be explained by the Barker Hypothesis. This idea suggests that brain development takes precedence over muscle building in undernourished fetuses.
— Academy of Finland and World Science staff. “Low birth weight may have effects 60 years later.” WorldScience.net. November 16, 2011.
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Country Contact Reports
Editor’s Note: For this international edition of E-News, we asked Midwifery Today’s country contacts the following questions:
- Are there traditional midwives in your country?
- What is their role?
- What percentage of births do they attend? Is the percentage increasing or receding?
- Is traditional midwifery legal in your country?
- Are midwives respected in your country? Why or why not?
Read our contacts’ reports and updates below. (Learn more about country contacts here.)
We have no traditional midwives in Slovenia—although I know my grandmother gave birth twice with a traditional community midwife at home. The midwives in general, I think, are not respected—they work in the state health system and vary widely in their attitude toward pregnant and laboring women. You are lucky to get a nice or warm midwife when you give birth, let alone one who would support a woman in her choices without remarks and pressure.
Efforts are being made to legalise independent midwifery so that a midwife would be able to make five check-ups during pregnancy and do births on her own, but we still have a long way to go.
— Ana Pavec
In Peru, the underground strategy to institutionalize birth is to ban homebirth and Andean and Amazonian midwives. Their role has been limited to accompanying women who still seek their counseling or treatment during pregnancy, to do walteado to women (girding) after birth, offer infant health treatment when sought, and give women counseling and treatment with herbs for general reproductive health throughout their reproductive cycle (including menopause).
Officially midwifery is not illegal, as the Ministry of Health knows that the number of public health centers and professional health personnel can’t cover all the rural population in the country. Local Ministry of Health workers tell women, their partners, and local Andean and Amazonian midwives that homebirth and the work of traditional midwives are illegal.
Midwives used to be highly respected by local rural communities for their wisdom and expertise, and although some women still respect their work, they receive mixed messages from the local government health centers which make them distrust the midwives’ ability to attend births and the safety of being attended by them. Others still trust their wisdom and knowledge, but have to go to the public health centers because they will be issued fines that they can’t afford. Public health workers, ingrained in biomedical culture, see Andean midwifery as backward and without value, although some of their practices such as vertical birth have already been proven worldwide to be better birth practices for women.
— Cynthia Ingar
In Kenya, 60% of women deliver at home, and the deliveries at home are mostly conducted by midwives. A few are conducted by relatives and some women deliver on their own. There are no legal regulations governing midwives. Women choose whether to deliver in hospital or at home, but most women who deliver at home do so not by choice. Poor access to hospitals make most women deliver at home in the hands of midwives.
Midwives have various roles in the continuum of childbirth: they do antenatal examinations, conduct deliveries and offer neonatal advice. They also refer women to hospitals in case of difficult labour. Midwives are respected in Kenya for role they play in childbearing. They contribute a lot in reducing maternal and neonatal mortality.
— Benson Williesham Milimo
There are no more traditional midwives in Portugal; there are hardly any midwives here. The professional training is on top of nursing and the model of care is between biotechnocratic and the human model of care.
Specialised nurses tell me that they are independent caregivers in a hospital setting, where all women have a drip, 70% have an epidural and the caesarean rate is over 30%.
— Mary Zwart
Midwives attend homebirths particularly in very remote areas where there are no skilled birth attendants available. They help with the household chores while waiting for the mother to deliver her baby. They also run errands for the family in the absence of the husband. They also do home visits after delivery.
It is with pride and honor to say that midwives are respected in our country. They gained the respect of fellow health workers and the respect of the community. Midwives are the barefoot doctors in the remote areas and constitute the largest workforce among health service providers. Statistics clearly show the confidence and trust of mothers in the hands of the midwives.
— Cecille Banca Santos
Traditional midwifery is legal in Belize, and midwives practice in the Mennonite communities and in rural remote areas. Midwives are respected in villages, as are lay health care workers. The Mennonite community uses outsiders for health care, but they very rarely employ outsiders for births.
Midwives receive training once a month at a meeting and discuss issues such as recognizing illness and referring mothers to clinics.
Homebirth is decreasing in Belize as older licensed midwives are growing old and new midwives are not being trained. Distance and transportation are the main problems in getting women to clinics and hospitals.
The majority of babies are delivered by nurse-midwives in clinics and hospitals. Most of these nurse-midwives are from Belize or Nigeria and they have women deliver in the only position they know—on their back and in stirrups. In addition, 98% of first-time moms receive episiotomies and there are no VBAC deliveries even when doctors are present.
— Gail Johnson
Read more country reports and full-length articles on international topics in the 100th issue of Midwifery Today magazine, now available!
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Choose from mandala prints, a set of four Mexican art prints, miniature clay sculptures and more. You’re sure to find something perfect for your midwife or doula, or for those new moms on your list.
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Birth Wisdom from the Web
When I was 29, I lost a baby because the only two midwives at our hospital were in the theatre (field) delivering babies. There was no one left to look after those of us in labor. My baby died because it went into distress and couldn’t be delivered quick enough. That is no reason for a baby to die.
— Esther Madudu, Ugandan midwife and advocate of improving birth conditions in Sub-Saharan Africa
In reality, healthy bodies come in all shapes and sizes, as do unhealthy bodies, and no single ideal size applies to everyone (even to all babies). But researchers would get a lot less funding, science journalists would get a lot fewer assignments, and the diet industry would make a lot less profit if people started believing that.
— L.V. Anderson, questioning claims connecting infant size to childhood obesity
I realized that being a midwife made me happy. Bringing someone to life is such a beautiful experience.
— Maria Fernanda da Silva, midwife from Caruaru, Brazil
If you’d like to share a bit of wisdom from the Web, please send a 4–5 sentence excerpt, accompanied by a link, to firstname.lastname@example.org.
Expanding your personal library?
How about expanding your local library with books that encourage natural and instinctual birth? How much information about natural and instinctive birth is at your library? As a patron of a library, you have a say about what books they carry. Let your library know you want natural birth and midwifery materials to be available. Your library is your resource. Use it.
Join Us in Harrisburg
We want to extend to you a hearty invitation to our Harrisburg, Pennsylvania, conference. This conference is going to be absolutely awesome. We have some excellent classes to help you improve your abilities such as Developing Your Breech Skills, two full days of Midwifery Skills, Twins, VBAC Skills and many more. Whether you are a doula, midwife, doctor or activist, you will find classes to help you become a wise birth practitioner. Our theme, “Midwifery: Skill, Wisdom, Culture, Love,” refers to the diverse cultural aspects of the conference. We’re featuring Marcos Leite, a “good guy” doctor from Brazil, Michel Odent from France (and now England), Tine Greve from Norway, Naolí Vinaver from Mexico, Betty-Anne Daviss from Canada, Ina May and Stephen Gaskin from The Farm, Amish and Mennonite midwives and many others. Most of these teachers have worked in more than one country and truly are people of the world with vast knowledge and deep insights about midwifery and birth.
As always you will be warmly welcomed and encouraged to make new friends. Our teachers are very accessible and willing to share with you. The events are designed to remind you of your love of birth and to strengthen your calling. They will provide deep learning and enjoyment. There is something for everyone, and moms are invited, too. I believe that if every pregnant mom could attend a Midwifery Today conference, each woman would acquire the skills and knowledge to have a great birth. They would learn so much, the medical monopoly couldn’t fool them into needless interventions.
We hope to see you in Harrisburg where we will learn, share, ponder, sing and dance together!
— Jan Tritten
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Think about It
The body of every woman knows how to give birth if we give [women] their sacred space, intimacy, trust and love.
— Fernando Molina
Excerpted from “Birth Choices in Venezuela,” Midwifery Today, Issue 86
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Homebirth and the operation of independent midwives have been unregulated in Hungary for the last 20 years. Although a government order came into effect in 2011, the situation did not really improve. The most experienced midwife of the country, Ágnes Geréb, has been imprisoned for more than a year, and several court cases are in progress against her and four other midwives. These cases clearly show the lack of equal and fair treatment of independent midwives and homebirth, compared to hospital cases. If you have any idea or recommendation about how to make steps towards the recognition of midwifery and homebirth in Hungary and in other countries of the region, please contact us at: http://freegereb.org/english/181-the-case-of-agnes-gereb-independent-midwife-with-the-hungarian-court.
— Anna Iványi
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