Let’s Move Birth in the Right Direction

Editor’s note: This article first appeared in Midwifery Today, Issue 128, Winter 2018.
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Complications are why we need midwives. If birth were completely normal all the time we midwives would not be needed—but, indeed, we are needed. It is so important that we all learn and gather the necessary skills and didactic and emotional knowledge we can before we take responsibility for a mother and baby. One of the great keys to a good birth outcome is knowing when and how to act and to do so quickly. Otherwise, we can keep hands off and be the quiet midwife in the corner—unobtrusive and loving. We need to be careful not to disturb the process. (See Michel Odent’s article in this issue.)

Sister Angela Murdock, who spoke at many early Midwifery Today conferences, often said, “Don’t practice wish midwifery.” That is, I wish this weren’t happening. You can lose “vital-to-life” time! Having skills, as well as heart and intuition, is imperative for a midwife. One of the best ways to augment your education is to attend a Midwifery Today conference and subscribe to our magazine and website. The membership part of our website has hundreds of past articles that have never before been on our website. Many are clinical and are still very relevant!

I know midwives are truly necessary and I believe that we hold one of the most important roles God has created. They were necessary in Biblical times—just as we are important today. Our vital role needs to be taken seriously because that solid foundation of a good birth is imperative to the health of the new human. It is essential for a strong, but peaceful and healthy, society. The new information on the positive effect of birth on the microbiome adds another layer to our importance. This information is still mostly unheeded in hospital birth.

It is essential that we midwives and other birth practitioners stop fighting so we can concentrate our energy on making midwifery the norm throughout the world. I am talking about a midwifery that is loving and motherbaby centered. This is not to dispute that there are well-established midwifery systems around the world where midwives are bullies and not family centered. There are places where midwives still slap and abuse women and bully each other as well. What I am talking about is the re-establishment of midwifery into a system that is respectful, kind, and loving. What would that look like? I think this is a question we all need to discuss so we can work toward a plan. It is hard to know where we are going without a plan.

Deb Puterbaugh has been talking about this for years now. She wants us to define midwifery and figure out who we are and what we are doing. Many of us believe that the NARM certification process is currently not working in that it limits midwives’ ability to practice the Midwives Model of Care in many places—where protocols are based on medical protocols, which are based on “standard of care” rather than on evidence.

What sane midwife would even suggest that women be routinely induced at 39 weeks? Most would not even suggest induction at 40–42 weeks. Midwives cannot have other practitioners controlling their actions or holding them to standards that are not midwife-determined. Midwives also need flexibility, because some consider breech and twins within their realm while others do not. Training and experience make variations of normal within the realm of the midwife. That choice should be up to the parents and midwife together. Autonomy is important and we need it.


Here are some of Deb’s comments to help us start thinking about these important issues:

  • Birth and death belong to the family.
  • Birth has become a commodity.
  • Birth is a public health issue.

We should be able to easily educate and support midwives as public health workers. The model hospice uses could well work for birth. Hospice is becoming better funded and supported. We now understand that families who are losing a family member need support. Hospice provides emotional, spiritual, medical, and social support to families losing a member. Families gaining a member need the same support.

It is time to meet, hash out details, and hold a summit to further move our profession in the right direction. Yes, the world needs midwives and we need a system that works to support midwives in providing the best care to families. Maybe you can join us for this summit. The time and place is still to be determined, but I will keep you posted.

Toward better birth,


About Author: Jan Tritten

Jan Tritten is the founder, editor, and mother of Midwifery Today magazine and conferences. Her love for and study of midwifery sprang from the beautiful homebirth of her second daughter—after a disappointing, medicalized first birth in the hospital. After giving birth at home, she kept studying birth books because, “she thought there was something more here.” She became a homebirth midwife in 1977 and continued helping moms who wanted a better birth experience. Jan started Midwifery Today in 1986 to spread the good word about midwifery care, using her experience to guide editorial and conferences. Her mission is to make loving midwifery care the norm for birthing women and their babies in the United States and around the world. Meet Jan at our conferences around the world!

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