Mothers’ Voices: Midwifery Care Makes the Difference
Midwifery Today, Issue 140, Winter 2021.
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Midwives the world over provide women with health care antenatally, during birth, postpartum, and when breastfeeding and raising young children. They provide education in all of these fields, as well as in family spacing, and also provide care in women’s general health. Midwives in different countries will have different regulations and rules for what care they can give, but all assist women during these transitional times of their lives.
I asked mothers in an international homeschooling forum that I frequent to tell me the ways in which their midwife cared for them that they believed they would not gotten elsewhere. These women are from several different countries and situations, but one prevailing theme in their answers was personalized care. The midwife saw each of them as a person and met them where they were—rather than as just another patient moving through the system.
“I had continuity of care by using a private midwife agency. We were in Australia. My husband ‘caught’ our daughter and he was so thrilled to have the privilege of being the first person to hold her! Continuity of care and personal relationship made a potentially frightening experience (having a baby after two miscarriages, in a foreign country, at an age considered ‘too old’ for a first child) much more comfortable.” (Australia)
“I saw the same two midwives for all my pre and post care, as well as the birth. And the first couple weeks of post-birth checkups were done at my home, so I didn’t have to cart us all out of the house. I had a choice of where to give birth (home or hospital).” (Canada)
“My second was born without complications at a birth center. We took her home a few hours later. No exhausting overnight in the hospital. The nurse came to our house once or twice … maybe at 24 hours and then at one week, I think. I loved this. That birth center was organized, established, professional. They brought a human touch to everything. I felt they were very life affirming. They were not oriented toward medical interventions but perceived pregnancy and birth as natural, normal, and something to be assisted rather than managed.”
“My last daughter was born through a birth center an hour and a half from the other center in a more rural area. This birth center serves a high percentage of Amish women. The office was rather disorganized, and they were less careful to make sure I met with all the midwives during my prenatal visits. The actual birth was fine. It was my third, so I wasn’t worried. She was born with her umbilical cord around her neck, but the midwife paused my pushes, calmly handled the cord and had me resume. We went home after just a few hours of resting. Aftercare was fine. The office situation was most upsetting in this practice. I felt that I had to advocate for myself. I never received any word from them after the one-week checkup. No offer of gynecological care or anything. Maybe Amish women don’t seek that kind of care so they don’t ordinarily offer it. But I sorely missed the other birth center that had cared for me as a whole woman, not just as a baby house. The midwives at the second practice were all good and competent. The birth was good and safe. But the overall tone of the place was not warm and life-affirming the way the first place was.” (USA)
“I wanted to be competently cared for and assisted through a frightening but exciting transition in my life, and my family and I felt that a midwife practice was the most likely place to receive that kind of care and help.” (Canada)
“I love my midwife. My appointments were an hour long, and we really talked and got to know each other. My older children were included and birth was seen as a normal thing, not a sickness. I appreciated that there was no pressure to do things you didn’t want to do, like pelvic exams and vitamin K. I was encouraged to do what my body was telling me and to position how I felt comfortable, which was never on my back. I personally feel that my midwife looks at you as a whole person, physical and emotional, and takes all of that into account. The bonus of post birth follow-ups being at home are awesome too.” (USA)
“My first birth was in a hospital in South Korea. I saw an OB (obstetrician) throughout the pregnancy who had studied in the United States and spoke English fluently. I ended up having what I now know is called prodromal labor—three days of contractions, three to five minutes apart, day and night nonstop. At the time I didn’t know it was normal and couldn’t figure out what was wrong with my body and my baby. We were admitted to the hospital after my water broke on the third day. Because the contractions were not measurably stronger, my OB recommended a c-section. However, the hospital’s head midwife—whom I had never met before that morning and who spoke no English (while I spoke very little Korean) —said she believed I could give birth naturally sometime within the next 36 hours. We split the difference and added a Pitocin drip to kick the contractions into gear.
“I didn’t see my OB at all until the baby was crowning. (Not even when they were discussing what to do—the interpreter told me about the disagreement and asked me to choose). The midwife checked in on me throughout the day, communicated with me, my husband, and my mom via charades and sound effects, gave me an amazing aromatherapy massage during transition, and coached me through the pushing phase.” (South Korea)
“Figuring out when to call the midwife is a puzzle, but she’s not going to increase intervention if I happen to call her early, and if we call too late, at least we have all the supplies ready and it’s not me we’re trying to get across town at that point. … One last thing—our last daughter was born not breathing, but she was never oxygen deprived because the cord was intact and still pumping. I held her in my arms and did mouth-to-mouth, and then the midwife took a turn doing the mouth-to-mouth while my husband and I talked to the baby.” (USA)
“One reason the midwife care was so effective is because my body doesn’t respond much to pharmaceuticals. I had taken iron pills before to no effect. My midwife had me change my diet and then I was 100% better. It was amazing! My midwife was also able to help when I had a lot of arm pain one weekend (agonizing arm pain—pregnancy-induced carpal tunnel, or something). She had me come in even though it was a Sunday. I felt the care was very personalized and effective for my body.” (USA)
“The freedom to make my own decisions regarding evidence-based care without regard to hospital policy and being trusted as a parent by my providers. [When I had to have one hospital birth,] for example, my provider disagreed with the practice of nothing by mouth for healthy laboring mothers and has a standing order that his patients get “clear liquids” (juice bars, broth), but the hospital won’t bend policy any further than that.” (UK)
“Having your main provider with you during active labor, instead of just during the delivery.” (USA)
“With my first birth, I believe my midwife saved me from much intervention (likely a c-section) at the hospital. My water broke near my due date but before I was in active labor. My midwife encouraged us to let my body progress naturally and she checked in with us both by phone and in person over the course of two days. We finally decided to try to speed things up by taking castor oil, which did increase my contractions but also left me dehydrated. After several hours of painful contractions with no progress, we thought we would have to go to the hospital, but my midwife first tried giving me IV fluids (in our living room) and I finally started to progress. My son was born a few hours later. The support and encouragement of my midwife through all of these challenges was amazing.” (USA)
“Relationship. I have known my midwife for eight years, and I trust her. She knows me and my specific circumstances and treats me like an intelligent human being. When I lost babies, she came to my house to check on my emotional and physical recovery. My regular appointments with her were close to an hour each. We talked about everything. She became part midwife, part mother-figure (my own mom lives far away). She prayed with me before and during labor when I was really anxious. I always knew my options, and I never felt pressured into (or out of) anything.
“Convenience. I never waited in crowded waiting rooms. My midwife often came to my house for appointments, and I was able to schedule my appointments at times that were good for me. I never had to arrange for child care, because my kids were with me at appointments. She came for postpartum visits probably five or six times in the first month.
“I love, love, love my midwife.” (USA)
“When I first got pregnant, I happened to work at a fertility clinic that shared a building with an OB clinic. So, I figured the easiest way to get care was to walk over to the other half of the building during my break. … I started out with an OB.
“And then it turned out that I had hyperemesis gravidarum. I got somewhat frustrated with the OB. It seemed hard to get him to see me as a person, really. I was numbers. My weight was okay, lab work okay, so it didn’t seem to matter that I was sick enough that I could not function. It wasn’t a medical emergency, so, whatever. I’m not that sick.
“The fertility clinic where I worked had a medical doctor and a certified nurse-midwife. I’d heard the talk they gave to their ‘graduating’ fertility patients about choosing between an OB and the midwives loads of times. The talk always made the midwives sound so homey and caring, so I decided to go ahead and switch. Especially because the birth center was right across the street from the hospital.
“I still wasn’t 100% satisfied with how the midwives dealt with the hyperemesis gravidarum, but they were significantly better. The OB would only suggest medication. The midwives would give me 10 million pieces of pregnancy nausea advice, none of which seemed to help, but they did at least seem to care. I noticed that it was significantly harder to convince the midwives I needed a Zofran prescription just to function, because they were super worried about how the medication would affect the baby; the OB did not seem much concerned about this at all. (Honestly, neither OB nor midwives were great at managing the hyperemesis. It was my physician employer at the fertility clinic who saw how sick I was day in and day out for all nine months who actually helped. Sometimes when I would come to work, he’d shunt me off to a patient room and give me IV fluids.)
“The thing that really converted me to the midwives was that they actually prepared me for labor and for possible complications and for breastfeeding and for parenthood in general. A significant part of each appointment was spent educating me. They even had the option to have ‘group appointments’ which was important for me because I was a complete stranger to the area and didn’t know anyone.
“I ended up having a premature rupture of membranes, but never went into spontaneous labor after a couple of days, so I was induced at the hospital with Pitocin. That was really hard. But … one of the midwives was there with me. I didn’t realize at the time how awesome that was, because I didn’t know it wasn’t normal. She’d suggest different positions and things to ease my pain. The only thing the hospital staff seemed to be able to suggest was an epidural.” (USA)
“With my son, I had a slow and long labour in the hospital with my husband, mother, and midwife present. As the time wore on, the midwife eventually suggested an epidural so I could rest and regain energy so other interventions would not be needed. I appreciated and trusted her suggestion in this, knowing we had already gone over risks of epidurals with her, and I knew her reluctance to use it unless she felt the benefits outweighed those risks. However, at this hospital it also meant a transfer of care to the hospital doctors/nurses/etc. The treatment under these doctors and nurses shocked me after the trusting informed care I had received from my midwife, including having a nurse who bossed me around and wouldn’t treat me as if I had any options in this system (legally in Canada we do) and an OB who gave me an episiotomy without my consent and treated me like an object more than a person.
“Overall, I had the epidural and Pitocin and my body responded accordingly; I napped as my body transitioned. Eventually baby was born and the midwife resumed charge of the situation. Yet … the respect, relationship, consent, trust I had in my relationship with my midwife was in drastic contrast with what I experienced of the hospital staff. I experienced trauma in that gap, and I feel triggered writing about it.” (Canada)
“My choice for a midwife versus an OB was due to the likelihood of receiving 1) more personalized care, 2) better continuity of care (likely for the midwife to be present versus whichever doctor was on call), 3) more emotional support, 4) greater acceptance of medical decisions we made than is typical with the standard medical model, 5) willingness to think outside the box to help solve issues, and 6) willingness to help with natural aftercare services.” (UK)
“[During] the second birth, she sat with me for at least five hours while I labored and then delivered. With the third child she was on her way to another city to see patients and turned around to sit with me and deliver my baby, despite another midwife in her practice saying she would do so. Then the fourth required induction because he was late. I was not happy about that, but the midwife said in her experience it didn’t usually work well to go later. So, I let her induce, but she was with me the whole day during induction. During all the births, when I needed to be checked for dilation only, she never checked me. By the third and fourth child she knew how dilated I was by my actions. She didn’t check frequently as a rule, anyway. I was allowed to labor and deliver in any position I chose. I was allowed to eat and drink, within reason, during labor while in the hospital. I was not required to be hooked up to an IV at all times, except during the induction. I was allowed to walk freely and was not hooked up to monitors constantly. I was allowed to go to the bathroom when I chose. I remember one hospital nurse looking aghast when I said I was going to the bathroom. My midwife just laughed and said, ‘Let her go, she’s never going to progress with a full bladder.’ I would not have been allowed to have a VBAC (vaginal birth after cesarean) without my midwife the last time. The supervising doctor refused to allow me to VBAC and after a horrible argument with me, he finally admitted he hates supervising midwives with a VBAC because he wouldn’t get paid. I promptly told him it seemed fair to me since the midwife didn’t get paid when I had to have a c-section.” (USA)
“I had my first child with a family doctor, second and third with midwife.
“Prenatal care was highly superior addressing nutrition and supplements that were tailored to my own health (family history, blood work, current research all being taken into account).
“Childbirth class had better info compared to the hospital class.
“Midwife was able to accurately predict size of baby within ounces based on feel, whereas family doctor guessed based on ultrasound and was quite off on the size (he guessed a whole pound too small) which brought up a whole lot of extra stress and narrowly avoided unnecessary intervention.
“I did not have any breastfeeding difficulties with my first with the doctor, thankfully, but felt I was ‘on my own’ doing hours of research to be prepared because it wasn’t addressed much in prenatal care or postpartum; the midwife helped me through a rough first few days with my second baby, including some middle of the night calls and help.
“My midwife did not make fun of me for saying I used natural family planning, like the family doctor did.” (USA)
“I didn’t significantly tear with my midwife because she coached me to push gently and slowly instead of ‘PUSH!’ and she didn’t tell me when to breathe or hold my breath (my oxygen and baby’s heart rate dipped a bit when I was in labor with my first with the family doctor and they slapped an oxygen mask on me, which startled me because I didn’t know what they were doing). I felt great after giving birth with the midwife, instead of sore and tired.” (USA)
“They supported my goals better. While they weren’t pushing interventions, they took concerns seriously if anything was wrong, like high blood pressure at the end of pregnancy when my other kids had hand, foot, and mouth disease and I was getting no sleep—things like that.” (USA)
Antenatally, women appreciate that they get to know their midwives and their midwives get to know them. The familiarity and trust usually bring about a safer birth than when neither caregiver nor patient are familiar with the other.
“We found almost total unanimity from mothers that they want their midwife to be with them from the start, through pregnancy, birth, and then after birth. Time and again mothers said that they hardly ever saw the same professional twice; they found themselves repeating the same story because their notes had not been read. That is unacceptable, inefficient, and must change.” (Bhardwa 2016) The continuity of care that midwives give lessens iatrogenic injuries and near-misses because the midwife knows the patient and her history.
In rural areas of the US and in developing countries where travel means a loss of a good part of the day, women who see midwives are more likely to keep their appointments because they have a relationship with their caregiver. “On average, prenatal midwifery appointments last 30 to 60 minutes and are designed to promote physical, social, emotional, cultural, spiritual, and psychological health. This midwifery model of care may better address the social determinants of health that especially affect birth outcomes for vulnerable women, compared to other models of care. Midwifery patients were also more than twice as likely to have an adequate number of prenatal appointments, at the appropriate times, compared to general practitioner or obstetrician patients.” (Muhajarine and McRae 2018)
In the wealthy areas of New York City, women are looking for midwives’ personal attention as well. “‘My friends who had the best birth experiences all went to midwives,’ said Ms. Young. ‘When you go to a doctor, you’re left alone a lot. You don’t have someone sitting there, looking you in the eye, getting you through it. When I thought about what I wanted for my child and how I wanted to have my child, every sign pointed to going to a midwife.’ The rising popularity of midwifery among cosmopolitan women also coincides with larger cultural shifts toward all things natural, whether it’s organic foods, raw diets, or homeopathic remedies. For other women, midwives offer a sense of control. ‘This is a time when women are asking more questions, getting healthy, wanting to be more empowered,’ said Ms. Kurkova, the 28-year-old model who gave birth to her son, Tobin, in 2009. ‘I didn’t want a hospital to take away my power.’” (Pergament 2012)
Midwifery care also provides extensive postpartum care to mothers that US obstetricians (and often hospital-based CNMs) do not give. Many of the US maternal deaths are in the postpartum period. In the first 42 days after birth, heart conditions, infection, and hemorrhage are the top three reasons women die (Declercq and Zephyrin 2020). National Public Radio researched these deaths and entitled their article, “If You Hemorrhage, Don’t Clean Up.” In it they gave story after story of women who died or almost died because their postpartum care was incomplete: high blood pressures went unnoticed, vaginal bleeding was dismissed, and women had to fight with caregivers to be heard and attended to (Gallardo et al. 2017). Midwives in the US typically provide five or six visits over six weeks postpartum, several in the mother’s home, and are available by phone anytime. This personal, frequent attention saves lives.
Anywhere around the world where a woman lives, a midwife’s care can make the difference between a safe, healthy, satisfying birth and otherwise. In more developed areas, the issues may seem more preferential, like having the setting and companions the mother expects, and being able to have an enjoyable, personal relationship with her midwife through long, regular visits; whereas in less developed areas, midwifery care may mean getting several prenatal visits and a knowledgeable caregiver at the birth who allows her to move around and has a hemorrhage medication should it be needed. Either way, a woman’s health and a family’s well-being are well-served by the midwifery care she receives.
- Bhardwa, S. 2016. “Community Midwifery Hubs Recommended by National Review.” www.independentnurse.co.uk/news/community-midwifery-hubs-recommended-by-national-review/115864.
- Declercq, E, and L Zephyrin. 2020. “Maternal Mortality in the United States: A Primer” Commonwealth Fund. doi.org/10.26099/ta1q-mw24.
- Gallardo, A, et al. 2017. “If You Hemorrhage, Don’t Clean Up’: Advice from Mothers Who Almost Died.” National Public Radio. www.npr.org/2017/08/03/541191480/if-you-hemorrhage-dont-clean-up-advice-from-mothers-who-almost-died.
- Muhajarine, N, and D McRae. 2018. “Poor women who use midwives have healthier babies.” https://theconversation.com/poor-women-who-use-midwives-have-healthier-babies-98294.
- Pergament, D. 2012. “The Midwife as Status Symbol.” New York Times. www.nytimes.com/2012/06/17/fashion/the-midwife-becomes-a-status-symbol-for-the-hip.html.