Part 1: How the American obstetrical profession can easily eliminate the “midwife problem” but would never consider it

by faithgibson on November 11, 2014

in 21st Century Healthcare in US, AB1308, new regs & new legislative efforts, Info ~ Medical Board Members, Mfry Student Issues

By faith Gibson, LM, CPM ~ former L&D nurse, mother, grandmother, childbirth educator, birth activist, professional community midwife, and a person who is never afraid to hope for a better future

Healthy women with normal pregnancies living in developed countries generally have no reason to worry about the basic safety of normal childbirth. Since pregnancy is such an intimate and internal experience for them, the parturient women inevitably see giving birth as something they are intimately involving in doing, as opposed to something done to them or for them by others.

From their perspective, advancing these goals is simple and straightforward: They want to be surrounded by knowledgable, trusted and familiar people who are able and willing to actively support them during the normal biological process of pregnancy and childbirth. To a healthy woman, the quality of her physical and emotional experience during vhildbirth and the broad social aspects of pregnancy and parturition are of profound and long-lasting significance.

It is the coming together of these factors that turns a couple into parents, and makes the threesome of mother, father and new baby into a new family.

Tradition midwifery (lay and direct-entry/non-nurse) in California in the early 1970s was originally the progeny of the new birth education movement. These two budding social movements were a political backlash triggered and fueled by the systematic refusal of the obstetrical profession to acknowledge and support the voiced needs of healthy childbearing women. What they were asking for, but not getting, was normal and non-interventive care before, during and after normal childbirth.

There has been a dramatic and century-long mismatch between the expectation of society and what the obstetrical profession is actually offering. During labor, healthy women need and want maternity care providers who support them in practical ways.

However, obstetricians, as trained surgeons, don’t see their professional role to have anything to do with the mother’s experience of biologically normal childbirth. The job of ob-gyn doctors is to assure that both mother and baby are alive and able to leave after a few days in the hospital. Realistically, the obstetrical profession is not a dependable source of assistance in this regard.

Nontheless the experience of labor is a very important for most childbearing women unless she is havinf a complication. Whenever a pregnant woman is unfortunate enough to have medical problems or a serious complication, her attention is entirely focused the obstetrical expertise of her doctors. But this is not a typical, since 85% of term pregnancies reside inside healthy women.

A comprehensive maternity care system must address the needs of all categories of childbearing families. Certainly those facing serious problems deserve all the help society can provide, but the vast majority of the childbirth population is healthy. Our maternity care system must effectively address the very different set of issues experienced by these healthy childbearing families.

What most healthy women want from their professional birth attendants is direct, specific, and something first-time mothers (naively it seems) fully expect to receive — the full time presence of their doctors while they are in active labor, when they give birth and the first hours after their baby is born.

The new-mother/new-baby period is also extraordinarily important to healthy women. Having just finished the reproductive equivalent of the Boston Marathon, a new mother expects and deserves to be congratulated on having won an Olympic gold for her perseverance and hard work, and praised for such a great outcome (every newborn baby is cute!).

During this first hour or so, other important physical, emotional and sociological issues require the careful attention of her birth attendants. The new mother should be made warm and comfortable, given food and drink and introduced to her first breastfeeding experience. This is the time and place that a newly delivered woman begins the lengthy, often stressful process of adapting to her new mothering role.

With the new baby safely in her own arms (not in a fancy baby warmer in a far corner of the room where she can’t see or touch her new infant!), she and her husband/baby’s father and/or other significant family members begin to bond with their newborn as a newly cohesive unit. She needs and wants familiar and trusted faces in the room to witness and remember this once-in-a-lifetime miracle for her and her family. For some strange reason, women universally expect that their birth attendant will be one of these ‘familiar and trusted faces’.

It is a real shock for first-time mothers when they discover that the ob-gyn doctor they expected to be present during labor did not actually show up until just a few minutes before the baby was born. After the placenta came out, and perhaps a few stitches were placed, that same doctor quickly disappeared again while their baby was only minutes old. Like a spurned lover, this is a disappointment that many new mothers don’t get over easily. They subsequently speak very cynically about their experience and are often moved to seek out the services of a midwife when they get pregnant the next time.

Part 2: Historical Overview

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