For compassionate, informed, powerful midwifery to continue evolving to its fullest potential in the twenty-first century, we need to expand our scope of guiding practices and principles beyond a single paradigm of any one system. The practices of obstetrics and traditional and evidence-based midwifery all are vitally important in development of an understanding of the nature of birth. When combined synergistically with our intuition and instincts, we can exponentially expand our perspective, helping us adapt to the wide spectrum of real-life individual birth circumstances.
By embracing the uniquely informed intelligence of all birth professionals—including traditional, granny, lay, direct-entry, and nurse midwives; doulas and other birthkeepers; and obstetricians and neonatologists—our perceptions and perspectives are broadened. By developing an interest and understanding of the strengths and weaknesses of each discipline, we will have an informed awareness to discover new possibilities and innovations, helping us find more effective ways to serve the great diversity of birth situations and the individual needs of each particular birthing mother/baby.
For ease and clarity, I have broken down the essential sources of wisdom, knowledge, awareness, intelligence, and understanding into five categories, which complement each other as essential guiding lights to improve our decision-making processes—leading to healthier, more successful, and more satisfying birth experiences:
- Experiential traditional midwifery wisdom
The body of feminine wisdom gathered through the millennia of birth-giving as a human race.
- Evidence-based midwifery knowledge
The research and direct observation of the physiology of birth through the eyes of the scientific method.
- Intuitive birth awareness
Using creativity, spontaneity, and inspiration to grasp the overall picture of what mother/baby need beyond the rational understanding.
- Instinctual mother/baby intelligence
The natural instincts as powerful forces pulsing from within, from the very first moment of pregnancy and throughout labor, birth, and beyond.
- Understanding forces and rhythms of nature
The cycles of life; forces of gravity, expansion, and contraction; the internal and external elements of nature.
Experiential Traditional Midwifery Wisdom
Midwifery is a feminine art and science that has been around for as long as human beings have been giving birth. Evidence dating back over two million years shows that the genus Homo (Homo erectus, Neanderthals, and, finally, Homo sapiens) were all social beings who worked together in clans.
As humanity evolved and social structures further developed, we see evidence of female-accompanied birth rituals depicted in art as far back as 20,000 years. Throughout history, the females who were experienced in birth have assisted and served as guides for birthing women, spreading their wisdom throughout diverse cultures and geographical regions. The ancient birth traditions, insights, and innovations have been perfected through the millennia. This has evolved into a vast and proven body of experiential traditional midwifery wisdom, which has been passed down from elder to younger midwives through countless generations all around the world.
Traditional midwives, at their best, have an intimate understanding of birth and a knowingness of the feminine spirit. They are often mothers and grandmothers themselves—living, breathing, and sharing the same experiences and needs as the women they serve. Midwives strive to work in harmony with the forces of nature, understanding the rhythms of birth. Many have experiential knowledge of the benefits of plant medicines; the physiology of effective birth positions; adjusting, massaging, nourishing, and warming the mother; and thus providing the aid for physiological birth to take place. The midwife is a caretaker and guide for both mother and baby, not only for the birth as an isolated event, but for the whole birth cycle—providing care and assistance from the prenatal period to well after the baby is born.
However, historically, in Western cultures, as monotheistic religions began to dominate, the vast body of women’s wisdom in many places was tragically pushed underground because it represented a menace to the dominating patriarchal religious doctrine. The atrocity of the burning as witches of countless thousands of wise women and midwives in Europe and its colonies (1400 – 1780s), together with the patriarchal religious doctrine, have cast a long arching shadow with extensive and oppressive repercussions up until the present day.
With the spreading of imperialism, colonisation, and slavery throughout the world, many displaced indigenous and native cultures have suffered greatly, including the midwives who have been marginalized, oppressed, and cast aside. In many cultures the traditional midwife as an entity has mostly and, in some cases, completely disappeared, leaving modern obstetrical professionals as the only option for birthing mothers.
Fortunately, through the fearless courage and resilience of many powerful women throughout history and around the world, the tradition of women’s healing and midwifery wisdom has managed to survive.
In many parts of the world, midwives continue to be essential sources of wisdom in their communities. Still, to this day, 40% of humanity is born into the hands of midwives, continuing the thread of traditional midwifery from the past to the present.
Evidence-based Midwifery Knowledge
With the scientific revolution and the birth of modern medicine, evidence-based scientific knowledge began to replace ideological religious doctrine. This revolution elevated critical thinking, which took us out of the Dark Ages and ushered in a new era of questioning and basing acquired knowledge on the scientific method. However, the science was not completely unbiased; it was still weighed down under patriarchally dominated protocols. By treating the human body and birth itself as a mechanistic phenomenon, losing its wholistic, natural integrity, the great body of women’s experiential birth wisdom that had been gained over the millennia was and continues to be marginalized to this day.
Evidence-based midwifery has come with new eyes to question, study, and research, using the scientific method in an expanded, inclusive manner. It is a problem-solving approachusingbest current research evidence from prospective and retrospective studies, clinical trials, controlled experiments, case reports, expert opinion, and scientific principles. This evidence is integrated with patient care data, the mother’s preferences and values, and clinical experience. Also, finding qualified mentors can be a valuable resource. This allows for a wholistic approach to choose a course of action in each particular case.
Evidence-based midwifery has been a veritable breath of fresh air, helping to revise obsolete detrimental obstetrical protocols and practices, which have remained the standard of care without being revised for many years.
Intuitive Birth Awareness
Intuition is a vital and important element during birth, combining creativity, spontaneity, and inspiration with sensitivity and awareness. Intuition helps the midwife see and feel the overall picture of what the mother and the baby may be needing, beyond the rational mind’s understanding.
If we simply follow protocols, just using the rational mind as a guide, innovation never takes place and birth wisdom becomes static and unchanging, rather than adapting and evolving to address each specific birth situation. Births are unique experiences to be unveiled. Without creative intuition, nothing new would ever be discovered and the solution to certain unforeseen complications would always remain a mystery.
Instinctual Mother/Baby Intelligence
The mothers’ and babies’ instincts are powerful forms of natural intelligence, stemming from our primal brain and responsible for our survival as a species. They are forces pulsing within, from the very first moment of pregnancy and throughout labor and birth. It is vital that we listen to these strong voices of nature, as they are perfectly designed as a guide to bring life forth into being.
Mothers and babies need birth professionals to adapt to their particular, unique needs—and not the other way around. Where the mother wants to birth, how she wants to birth, with whom she wants to birth, in which positions, and even when she will give birth are all clear beacons of light stemming from the core of each mother/baby. In most cases, if we give the mother/baby space and pay close attention to all the signs, their natural instincts will lead the way to the perfect unfolding of the physiology of birth.
Understanding Forces and Rhythms of Nature
Nature embodies and shapes us through inner and outer vital forces. These forces are a combination of the human body’s adaptation to its environment and all external physical forces of the universe, such as gravity, the phases of the moon, the ocean tidal waves, the cycles of night and day, the temperature, the presence of water, and many more.
All our inner forces and rhythms have been shaped by nature, including the menstrual cycles, circadian rhythms, contractibility of muscles, production and release of elaborate combinations of hormones, electro-chemical reactions, and more.
The timing and rhythms of nature can determine the successful flow of labor and birth. The duration of pregnancy, exact moment labor begins, when the waters break, how long labor lasts, the precise time the baby is born, and the birth of the placenta all obey the natural timing of physiological birth.
All the forces and rhythms of nature work together as the strongest guiding force of all, in a magnificent orchestration which can be poetically called “the dance of birth.”
Combining and Applying Guiding Principles and Practices
It is of utmost importance to be in a constant state of learning, growing, and expanding, approaching each birth with a fresh open mind instead of a preconceived idea of how we think it should be. To incorporate these sources of wisdom, knowledge, intuition, awareness, and understanding into our own birth practices, we must bring together disparate elements of perception. Being both open-minded and discerning, analytical and intuitive, laser-focused and broad-minded, challenges us to step beyond our comfort zone, which then leads us into a broader awareness.
To begin perceiving the world of birth through the eyes of a traditional midwife, we must go directly to the source. Traditional midwifery wisdom is a live art that takes many years of experiential practice. Therefore, doing an apprenticeship, internship, or simply studying with a traditional midwife is the best way to gain insight into the experiential wisdom of traditional midwifery. Even a shared opinion or piece of advice from a traditional midwife can be very valuable to a particular birth situation.
Evidence-based midwifery has an ever-growing extensive body of researched knowledge, which today can be easily accessed with the simple touch of a finger. Networking with pioneers, colleagues, midwives, and humanized obstetricians around the world—who have vast experience on specific subjects—is always a fast and effective resource. Reading and studying updates of protocols, current research, and new evidence will keep us at the forefront of birth knowledge.
To develop our intuitive awareness, we need to acknowledge and listen to our inner voice. It can be subtle and at times confusing to discern which is the voice of true intuition, differentiating it from the voices of the mind that stem from cultural and clinical preconceptions of what we already know, wish, or fear. To quiet the mind allows us to become aware of perceptions and emotional sensations, so we can marry the right and left sides of the brain, translating into inclusive awareness and allowing for critical thought and intuition to participate together.
The instinctual intelligence of the mother/baby is designed to guarantee survival and vitality. When we are in the presence of a birthing mother, we can observe that she and her baby are immersed in the unfolding of their instinctual process. These natural instincts are quite powerful, yet they are also easily disrupted. Using all our senses, as birth attendants we should strive to not interfere, but to identify when mother and baby require assistance.
This also applies to respecting the forces and rhythms of nature. When possible, we should not allow our fixed protocols or belief systems to interrupt these natural cycles, but rather, with understanding, allow them to unfold naturally with their own intrinsic perfection.
Let us look at a concrete case scenario of how we might integrate these guiding practices and principles, weighing risks and benefits carefully:
- Camila, a primiparous 30-year-old mother, has a premature spontaneous rupture of membranes (PROM) at 38 weeks gestation, with no other signs of labor.
Camila’s care unfolded in the following manner:
Using traditional midwifery wisdom recommendations, Camila had no vaginal exams and drank a few cups of cacao/herb stimulating tea per day. To warm her body, instead of the traditional Temazcal, she took long, hot showers three times per day and drank plenty of water until active labor began.
Using evidence-based midwifery, Camila followed a protocol of infection prevention measures, every four hours checking: her temperature; pulse, color, and smell of amniotic liquid; and baby’s movements, fetal heart rate, and variability. She took 500 mg of vitamin C and propolis/echinacea. Hourly she drank a large glass of water to replenish the production of amniotic fluid. No vaginal exams were done, to avoid risk of infection.
Based on Camila’s instincts and her midwives’ intuition, to invite the energy of birth she alternated between taking long walks and nesting, away from social gatherings.
Following the rhythms and forces of nature allowed for trust in understanding that following spontaneous PROM, the baby’s lungs reabsorb the fluids, creating a vacuum in preparation for the first breath. Simultaneously Camila’s cervix began to soften and mature for birth. Evidence-based midwifery knowledge demonstrates that most mothers will spontaneously go into labor within 72 hours of PROM, superseding obstetrical protocols of induction or c-section within 12–24 hours.
In accordance with the rhythms and forces of nature, Camila went into labor three days after her membranes had ruptured, followed by a five-hour labor, which began spontaneously. With the attentive patience and understanding of the birth team, Camila had time to mature all hormonal levels and give birth to her baby in full health and perfect timing.
Working Together for Birth
It’s important that we support each other, building bridges that allow for the generous sharing of information and experiences amongst birth professionals of all origins, walks of life, and specialties.
Go to the other sources with an open and curious mind. Do not throw away what you don’t understand, but choose what adds to and improves the outcome for mother/baby, sometimes expanding your own protocols to accommodate a special situation in a safe way.
We might consider that, while many effective protocols and practises remain in place, we should never treat them as absolute doctrines, but simply as safeguarding general guidelines. They can’t possibly take into account all the variables of each unique, individual situation, as they don’t consider all of the specific physiological, personal, cultural, and social elements, all which can make a difference in birth outcomes.
If we allow all aspects of wisdom, knowledge, intuition, awareness, and understanding to stand equally together inside of us, we can become the most effective and powerful midives we can be.
When human beings work together, supporting each other and exploring all of our potential, the sum of the whole is truly much greater than its parts.
Let’s celebrate our diversity, being inclusive of the great variety of approaches and ways of being and bringing together all of our capacities and gifts with an illuminated understanding. This way we can continue to brilliantly serve the wide spectrum of birthing needs of mothers and babies far into the future.