Traditional midwives have been around for thousands of years and may also be referred to as community midwives or the more narrow term, traditional birth attendant. They are important and respected community members often with little or no formal education, but have learned their skills through apprenticeship. Some may be chosen by the community, while others may choose this role, or it may be passed on through family relations. Often, they are skilled in not only cultural practices, but other methods of healing including traditional medicines or herbs and spiritual healing. Some have completed trainings in more formal or institutional midwifery skills. Traditional midwives attend the majority of births in the global south and are trusted members of the community.
Midwifery has a particular contribution in preventive and supportive care in promoting positive outcomes, and that is most effective when midwives are educated, trained, and regulated, and integrated within a healthcare system, and with effective teamwork.
So what is midwifery care?
Midwifery is the oldest of profession. The Midwifery Model of Care and Shared Decision Making is based on the fact that birth are healthy and normal physiologic events. The official Midwives Model of Care document was written in 1996 by several midwifery associations and the lay group Citizens for Midwifery. It was designed to provide shared language about the kind of care midwives offer. This model of care includes a midwife’s obligation to monitor the physical, psychological, and social well-being of the birthing person and baby in a holistic and patient centric way. That care should not be designed around the needs of those giving care, but of those receiving care. That care should support normal physiologic processes with intervention that responds to medical needs only.
Midwives view clinical information in the context of a woman or birthing person’s life and unique self. Midwives provide individualized education, counseling, and care. They believe that a birthing person is capable of gathering information and making a decision that is right for them and their baby. Midwifery care encourages a birthing person and their partner to take responsibility for all decision making, while the midwife provides tools and resources to assist them in this process.
When thinking about evidence-based midwifery care, it is important to look beyond what care is provided by whom. In other words, it is not enough to consider the number of births that occur in facilities, or the percentage of births attended by skilled birth attendance. Rather, there is a growing awareness to consider how care is being provided as well.
Many midwives offer continuity of care and provide prenatal, birth, and postpartum support for their clients as opposed to practicing in large groups where relationships are harder to form. The midwife minimizes use of technology without compromising safety. They use their hands and heart-centered knowledge to observe and draw conclusions about the health of a pregnancy and birth. Midwives use blood pressure monitoring devices, stethoscopes or dopplers to listen to the baby, and lab testing as necessary to monitor the health of the birthing person and baby.
Shared Decision Making is a core value of midwifery care. This process provides midwives and parents the knowledge that all decisions made regarding care during the prenatal, birth, and postpartum periods are made together. It is the midwife’s responsibility to ensure that educated decision making is accomplished, through the sharing of evidence-based research and experience. It is the parent’s role to actually decide upon a course of care.
How do I go about hiring a midwife?
The first step in hiring a midwife is understanding what you are looking for and articulating your needs. Understanding that there are only about 14,000 midwives in the USA, 6% are People of Color and 2% are Black. This means that there are not nearly enough midwives to meet the growing needs of BIPOC individuals who are seeking birth support. Organizations like Mama Glow Foundation are working to support the educational advancement of BIPOC and LGBTQ+ midwives. You want to make sure your provider can give you culturally congruent care.
Bring your birth village together and make a list of things you desire in terms of care for your pregnancy and birth. Envision your ideal experience and give name to what’s important to you. Once the list is complete and you have a clear idea of what you desire you can start interviewing providers. Lots of midwives offer virtual or in-person consult meetings. These are typically complimentary sessions that provide you with the opportunity get to know them learn about how they practice and what their philosophy is. They can answer questions you may have. But you are really checking for a vibe, to make sure you feel comfortable with this person.
Questions I should ask when interviewing midwives:
Most people are concerned with whether or not they have found the right fit. Connect with your heart to decide the right fit. Here are some questions to bring into your meeting with the midwives:
- How long have you been practicing?
- How does your practice work?
- What does prenatal care with a midwife look like?
- Are my appointments at home or at your office?
- Where do you practice?
- Will a midwife apprentice be involved in my care?
- What happens if there’s a complication in my pregnancy?
- What is the plan if I’m post-term?
- What happens if there is a complication during labor?
- Do you use herbs or any natural techniques?
- Do you offer home-birth, hospital birth, or do you deliver at a birth center?
- How would we prepare for home-birth?
- What healing modalities are you trained in?
- What postpartum care do you offer (herbal support, abdominal massage, breastfeeding support)?
- What newborn care do you provide? Do you offer newborn testing?
- If I deliver at a birth center, how long would I stay there afterward?
- Do you make postpartum home visits?
- How are postpartum visits conducted?
- How often would I see you during my pregnancy and postpartum?
- What type of practitioner referrals do you offer?
- How do you work with doulas?
- How do you accommodate clients in the event of a pandemic?
This is not the time to settle on your care, you really need to like your provider. If your intuition tells you something is off, keep looking. This is a special time for you and your family, take your time and enjoy the journey!