A Thousand Hats: Each Midwife’s Role(s)
Midwifery Today, Issue 141, Spring 2022.
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There is a nursery rhyme that goes “Rich man, poor man, beggar man, thief, doctor, lawyer, Indian chief.”
When Jan asked me if I would write an article about “The Midwife’s Role,” I wasn’t sure what she meant. I mean, isn’t it self-evident that any midwife’s role is to be a midwife … that is, to see women during their pregnancies, to attend their births, and to do postpartum care? However, as I thought about it, I realized that within that title, there are a number of other titles that are part and parcel of this work that we do, this calling to which we are drawn.
We wear many hats.
We are interviewers, for when a pregnant woman first calls us to inquire about a homebirth, aside from telling her about our philosophies and practices, we are asking her many questions to determine if she is a good “candidate” for a homebirth. We have learned a number of skills to help us find out “where she is at,” what her beliefs are, and what reasons have led her to consider staying at home.
We are nutrition counselors. We have to know a fair amount about food and health and about what helps to make a healthy uterus, umbilical cord, placenta, mommy, and baby. We need to know about different eating styles and choices. I, for one, am grateful to my mentor midwife for making things really simple: Drink water. Eat whole foods. Eliminate white sugar, white flour, caffeine, and dairy. (We are the only mammals who drink another mammal’s milk and I believe that that milk is for calves, not humans.) Combine foods: eat a protein, fresh fruit, fresh vegetable, and whole grain instead of just grabbing one of those at a time. Whatever you would be proud to hand to your two-year-old, you can eat now because this baby will be that two-year-old in the blink of an eye!
We are encouragers. Take a walk today, play in the water, move your body. You will feel better, sleep better, and birth better when you have been active and you feel strong.
We are soothers, reassure-ers, fear-reducers, calmers. We learn how to help anxious pregnant parents so that they feel more confident, excited, peaceful, and relaxed each and every time they leave their visits. We teach breathing exercises, relaxation techniques.
We are hostesses and smilers. We greet people at the door, offer them fruit (in the winter, some homemade soup) and nuts, and there is always a pitcher of water because we never know when a pregnant woman might have rushed to get to the appointment without having had time to eat—or if that is a growth day for baby and she is hungry every few hours.
Many of the women who see homebirth midwives are stunned by how much fun the appointments are. In their previous experience, during which they went to an obstetrician or medical midwife, they may have waited at times for up to an hour before being seen, and then had only been seen for about 10 minutes, tops. I have been told that six to eight minutes is the mean for prenatal visits in the US—by someone who may never have had a baby or seen a truly natural birth and who may not even be at the delivery. These moms are so relieved to have unrushed, relaxed, happy visits this time around.
We are, in a sense, birth psychologists/therapists/coaches, although we most likely would not use those words. I looked up the definition of therapist and found this: “Establishes positive, trusting rapport with patients…. Creates individualized treatment plans according to patient needs and circumstances. Meets with patients regularly to provide counseling, treatment, and adjust treatment plans as necessary.”
I think about a woman, Eileen, who came to me after having had four cesareans and desperately wanting a normal, vaginal delivery at home. She had been on antidepressants since the birth of her first child, having been diagnosed with postpartum depression after each one. She had been referred to a psychiatrist a few weeks after baby #1. The first time she came to see me, we were together for three hours. I held her and rocked her as she cried. Another time when she came to see me, we role-played each of her births—but gave them different endings. She “birthed” each of those cesarean-born babies vaginally; she called two weeks after that visit and told me she hadn’t taken her medication since the day she left my house. I was not comfortable with that, but she explained that she felt listened to for the first time in years and that she realized she had every right to be upset over what had happened to her each and every time she went to give birth. Although she knew that she’d had c-sections, pretending to birth normally had been very powerful for her: she felt as if the reenactments had helped her in many ways.
I spent many more hours with Eileen over the next months. I made it clear that I was not trained as a therapist, but as a woman who’d had a cesarean. I understood perhaps some of what she was thinking or had gone through and knew some of the things that might help her feel better all around. She gave birth at home to her fifth child, found a new psychiatrist who helped her wean from her meds and hasn’t taken any since then. Please note that I am not advocating chucking one’s medications or psychiatrist after a visit with a homebirth midwife—but I am suggesting that our role as patient listeners, cuddlers, suggesters and idea-givers goes a long way toward helping women heal.
We are planners. We have to learn to think ahead about possible outcomes. We have to make, bake, and freeze meals and our childrens’ birthday cakes so that when we have been up all night at a birth, we have either a meal to serve or “things party” all set and ready to roll. We are movers and shakers. The birth world is, indeed, a mess, but I often remind myself how much more of a mess it would be if we all hadn’t been doing what we had been doing all these years … decades.
We are cooks and bottle washers (but not baby bottles—we don’t need those when we support our mothers as they breastfeed). We are laundry-folders, as well as occasional vacuumers and babysitters.
Tina came to Massachusetts from another state a month before her guess date to give birth vaginally after several cesareans. Her husband was going to join her but needed to work for two more weeks. Tina brought her three children and her mother along so that her mom could help. Her mom got sick a few days later, and Tina was nine months pregnant in an unfamiliar city with no friends. My student midwives and I took her to the market and helped her with food prep. We played with her children several afternoons in a row so she could rest. I actually let go of one of my students when I asked her to help out and she said, “I didn’t sign up to watch kids when I decided I wanted to be a midwife.” No, Mary, you are right, that was not part of the job description, but still, it is what we do when called upon to help one of our clients.
We are language buffs. We do what we can to help change the collective birth mindset by using words and phrases that help women feel powerful and strong. For example, we refuse to use the term mucous plug: what woman who wants to feel the full ripeness of her femininity when she is pregnant wants to think there is a glob of snot in her vagina? No, it is baby gel. What is this ridiculous term “due date”? It is nothing but a way to trap women into being induced. We change the word “pain” to power—after all, pain is a signal that something is wrong, while the sensations of labor are a sign that everything is right. We use positive words; we change the fear-based way of talking about birth into strength-producing thoughts. What midwife hasn’t heard one of her moms (they are not patients, by the way.…) say, “This is the first time I have been excited about the labor instead of dreading it”?
We don’t call pregnant women patients; they are not sick. Neither are they clients. And don’t get me talking about the word “doula.” How it caught on is beside me—ask anyone who is Greek. I use the word “labor assistant.” We don’t “deliver” babies. The mother delivers her baby. And we don’t “do” births. It’s like fingernails on a chalkboard to hear a midwife say “Oh, Jenny? Yeah, I did her birth.” (The mother “did” her birth and she gets the credit. We attended her.)
While we are on the subject, I heard the word “medwife” years ago and all I can say is, “if the shoe fits….” Sadly, so many of the women who call me tell me that they selected someone they thought was a midwife, and, well, she wasn’t. She was masquerading as one but showed her true colors long before push came to shove. Or maybe her definition of midwife was a far cry from what the word has meant from the beginning of time.
We are breastfeeding advocates. We are birth gurus (spiritual teachers, especially those who impart initiation) and, yes, we could at times be considered birth junkies (in the best sense of the word, of course). We are intactivists. Male babies are born perfect and don’t need a part of their bodies amputated. We are determined, firm, independent, resolute. We are visionaries. We are recordkeepers, although if the truth be known, I must say that I am among those who strive to be better at this.
We are teachers, educators, instructors. At each visit, heck, even when we are out there in the world, we are talking about birth and informing those around us about natural birth. We are politically active—note that I did not say we were politicians. We are thinkers. On occasion, we are seamstresses, although we do everything we can to preserve the birthing mother’s perineum. I love to sew, but I prefer to sew fabric rather than people. I remember the words of another mentor midwife: “You treat that vagina as if it was your own; you want to be able to sit on it and make love using it without any interruptions in time!”
We are sometimes sex counselors and marriage counselors. Pregnancy is a time when so much is happening between couples and we are called upon to do what we can to strengthen the bond between the couple and to help them as they enter parenthood.
We are trusted friends. I have heard some confessions that would put hair on most chests (the woman who wasn’t sure who the father of the baby was because she had gone to a party and had sex with several men that evening; the woman who thought she might throw her baby out the window; the woman who was the surrogate for her sister and decided she was going to keep the baby.) We are referrers and occasionally reporters. We are team members and must know when we are in over our own heads and what to do about it.
We are “I can fall asleep just about anywhere-ers.”
We are advocates—we advocate for both mother and baby. Is induction ever really the best course of action? I mean, if the mother’s body was ready, if the baby was ready to be born, labor would have started. If she. Does that baby really need a Hep B injection/formula/etc.? Have you waited a good half hour or longer before cutting the cord—what is the rush? You get the picture. We are—albeit at times, reluctant—legislators, working with lawyers and lobbyists to educate the public and do our best to get laws passed that will benefit and serve—the women we serve.
We are role models. I have let go of student midwives who smoked, drank, or ate nothing but crap. I let go of a student who continually wore very suggestive clothing and who, having met the soon-to-be daddy for the first time, said, in front of the woman, “I sure wouldn’t mind having his slippers under my bed.” Pregnant women feel lots of ways, but often they feel heavy and cumbersome and they need reassurance, not competition. It’s not that we have to be perfect, not at all. However, there is a certain emotional connection/internal ambiance/genuine empathy that lends itself to midwifery—and other things that don’t.
We are strivers—to be our best selves, to reach toward health, to remain centered and focused and attentive to our clients and to the situations that arise.
We are chameleons, another important concept I learned from my incredible mentor midwife. We do our best to fit in when we go to couples’ homes, to learn what this particular family believes, to honor this family’s roots, and to embrace and enjoy as many of their traditions as we can when we are with them.
We are singers, albeit, sometimes off-key, as we sing a sweet and gentle “Happy Birthday” song to each of the babies shortly after they arrive.
I attended a labor once that was long and unproductive. There was little change in the cervix despite all of our suggestions, patience, love, encouragement, and positive thinking. After quite some time—a day and a half—we transported to the hospital. The mother was disappointed, as were we all, but it did feel to all of us as if it was the right decision. When we got to the hospital, the mom had an epidural. She was the same 6 cm that she had been for all those hours. The baby sounded good and she was given Pitocin. Eight hours later, she was examined and told she was 10 cm and could push. She pushed a few times; however, they lost heart tones. A few minutes later, the baby arrived—stillborn. No words.
The couple’s parents were all waiting downstairs for good news. This was the first grandchild for both sets of grandparents. I was sent downstairs into the lobby and when they saw me coming toward them, they all jumped up, excited to hear about the baby. I was the one who was designated to bring them the news—and it wasn’t good. And so, my role was that of bad news bearer and for many weeks following that birth, I felt as if I was called upon to be a type of grief counselor. This has also been the case many times when women mis-carry or something goes wrong during a pregnancy. No matter what our individual spiritual or religious beliefs may be, we become pray-ers for the family—affirming for positive outcomes and asking for strength and faith when things aren’t going, or haven’t gone, well. It is difficult, I think, and possibly impossible, to be a midwife and an atheist at the same time.
On the other side, we are happy memory makers. We help to bring so much joy, strength, and delight to our couples during pregnancy and afterward. We are so many things. Our roles as homebirth midwives are numerous, varied, changing, challenging, and exciting. Some of them are difficult, exhausting, scary, and unnerving and others are filled with absolute jubilation, triumph, elation, and gratitude. We are storytellers. It is such an important part of what we do; through the stories and anecdotes we tell, we give birth to confidence and determination.
How many of us have been to weddings or other gatherings, only to find us dispelling myths, correcting misinformation, and telling about wonderful births because as soon as anyone found out we were a midwife, they wanted to talk about their horrible experiences or tell us how they—or their daughters—had to have a c-section. I was once in a dressing room and overheard the woman in the next cubicle telling the friend who was with her that she was scheduled for her c-section on Monday. I waited for her to come out and told her that I’d had a c-section and then had a normal birth. I didn’t know if she would be annoyed, angry, or upset with me, but I handed her my phone number. She called that night, canceled her c-section, and had a VBAC 10 days later.
It is imperative that we do not become ultrasonographers. I am among those who are not at all convinced that ultrasounds are safe for babies and the fact that they are used routinely, earlier and earlier in pregnancy, is of great concern to many of us. I join those who strongly believe that they should not be used routinely but only in rare situations when it is necessary to have information that cannot be garnered in any other manner.
Midwives becoming more and more technology-oriented and increasingly medicalized has not shown to improve outcomes. Over and over again, I hear women who have turned to homebirth because they were dissatisfied with their experience in a hospital or birth center, label the “midwife” who attended them as “the computer-inputter” or the “EFM-watcher.” The United States’ rank in the world, despite or maybe because of the number of tests performed and/or the way labors are evaluated, is appalling. We should not become gender-revealers. There are many extremely important reasons for waiting until the baby is born to find out “what kind of baby” has been born, and for midwives to understand these reasons and help influence couples to wait, once they do.
We are confidantes. I received a call just last week from a woman whose birth I attended 12 years ago; her mother was dying, and she burst into tears when I answered the phone and told me she just needed to hear my voice. We are secret-keepers, getting calls to “hold a space” a few months down the line—even when the woman had not yet told her family, or even her partner, that she was pregnant. It would put hair on one’s chest to hear some of the private things that midwives are told. We are comrades, “sisters on the journey,” with other midwives—those who are geographically close and with whom we assist or meet up … as well as those we have never met. As connected as we are to our non-midwife friends, we have a bond with those who, like us, are always “on-the-ready” whether it be in the middle of cold, icy nights or during a holiday, those who understand the intense responsibilities, concerns—and joys—hat being a homebirth midwife involves.
As midwives, our roles are numerous, specific, crucial, critical, indispensable and essential. We have been maligned, burned, almost eradicated, banished, put down, challenged, and ignored. We have been lifted up, appreciated, honored, cared for, and loved.
Among our most cherished roles are those of birth preservers and bond protectors. What we do by taking excellent care of the women and babies who put their trust in us, is, indeed, life preserving and mother-baby bond safeguarding. As one woman said, “I was drowning in fear and sorrow after my first birth. I had been induced, my body was not ready to give birth, and I labored for days. I was threatened with a c-section all the time I was there. I managed to have a vaginal birth, but through no support on the part of the staff there—they [couldn’t] have cared less. My baby was poked and prodded for no good reason. This time, you threw me a floating device … heck, you jumped into the water and pulled me into your boat. You warmed me with a towel and tucked my baby under it with me and with your love. I will be forever grateful.”
Finally, we are rememberers. We are those who carry the blueprint of natural birth in the cells of our bodies and keep the light of that way of bringing babies into the world alive. This is one of our most vital roles on the planet, now and forever.
We are not monetarily rich, but we are rich in so many ways. We are not doctors or lawyers or Indian chiefs, although I know a midwife who became a doctor and a doctor who became a midwife. I know a midwife who became a lawyer and a lawyer who supports midwives. I think about all the Native Americans babies born on the plains and surrounded by nature since the beginning of time. We study hard and we sacrifice in many ways so that we can serve in a role that many are either not interested in or not suited to be a part of. We rejoice in each and every newborn’s arrival onto this planet, into this world—this crazy, unpredictable world.
We are Midwives.