I will admit, when we were expecting our first child 12 years ago, we had a rather short-sighted view of midwives – we thought they give something less than doctors, that a doctor is something “superior”.
Now I can only be ashamed of my ignorance. Already during the anticipation, visiting both the doctor’s care and the midwife in weekly preparation classes, seeing how much the midwife can provide, our thoughts changed.
The midwife has a deep knowledge of physiology
The midwife has studied the physiological side of pregnancy, childbirth and the postpartum in depth.
The doctor learns more about the pathology and complications and how to solve these problems. So no one is lower or higher – everyone has their own field of action.
The midwife can distinguish between where the natural course of childbirth ends and the complications she can deal with, and where the doctor has to get involved, because the pathology has started.
Positioning and orienting the baby can change the baby’s birth easier.
By getting to know a woman in advance and delving into her emotional world, an attentive midwife can feel the emotional difficulties that interfere with childbirth and help to address and overcome them, psychological factors influence because childbirth as a physiological event.
Let’s say it can happen that childbirth stops because a woman fears that she can’t take care of little one.
It is best if the woman has been in contact with the midwife before, established a relationship of trust and discovered these fears. Then it is easier to say them in time and find encouragement.
But sometimes some fear in childbirth can escape, and even then the right words or silence, a touch at some point, can help ease or dispel them, and the birth can move on.
By that I mean that working as a midwife is not just about a woman’s body, it is largely an emotional, spiritual support.
It is easier to have a midwife with you during childbirth
In most cases, a midwife stays with a woman for longer than a doctor, even if she is a contract doctor.
If a woman gives birth without a contract, she will still have access to a midwife and a doctor on call, who may also change during childbirth.
With a contracted birth, one midwife will be available throughout the birth. How intensely – this should be asked before agreeing, because it can also be different.
There are women who choose a contract mother. And the reviews are different – someone is happy that this opportunity was used, for another the experience was not the best – it was not worth it.
The contract does not yet provide any special care, except that there will be this particular midwife. However, you need to invest some energy and time to get to know the midwife, and reciprocally.
It is worthwhile for the woman herself to first understand what is important for her in childbirth and to discuss the possibilities that may or may not be experienced from it together with the particular midwife and that may disrupt these possibilities.
I recommend trying honestly to feel that you are compatible, because in childbirth a woman is naked both physically and emotionally.
Ask yourself – will you be able to be naked in front of this midwife in any way? What does the mind tell you? Emotions? Are there suspicious feelings in your body that show, for example, the stress of being with this person? Do you feel calmer in her presence?
How many times in your life will you give birth? Mostly two, three, some – more. However, I think that is not enough to prepare carefully for each experience.
Research-based benefits of the midwifery model
It is the long-term existence of a midwife with a woman, the knowledge of natural processes and the methods that support them, which has proven itself in studies with better results in childbirth, a woman’s well-being afterwards, breastfeeding and feelings in the postpartum period.
A large pool of 15 studies of 17,674 women in continuous midwifery care (including during pregnancy) found that the midwifery model includes:
- There has been less need to use local anesthesia and other anesthetics during childbirth;
- Less instrumental vaginal delivery (such as vacuum use, incision);
- Less premature births;
- Fewer overall deaths before and after the 24th week of waiting, as well as fewer neonatal deaths;
- More likely to experience spontaneous vaginal birth (i.e., without induction);
- The pericarp was less frequently pierced;
- Less frequent episiotomy or perineal incision;
- Longer births;
- A more likely midwife is likely to attend the birth;
- There was no difference in the number of caesareans and in how often there were no ruptures at all.
In the absence of a consistent way to measure women’s satisfaction and the cost of a midwifery-led care model, these aspects were described.
Most of the investigators included reported higher levels of maternal satisfaction with midwifery-driven continuity of care models. Similarly, there was a tendency for the midwifery care model to be more cost-effective than other care models.
Another small study in Lebanon, which involved a hundred women, shows that child birth is more successful when midwifes doesn’t change.
Namely, half of the study participants were cared for by one midwife from the active period of childbirth (approximately five centimeters of cervical orifice), while midwives changed in the control group.
It turned out that women with one caregiver had fewer tears and less need to use artificial oxytocin.
These are just a few of the studies that show the results of the midwifery care model, not a few.
The midwife works not only in childbirth
Often women do not even know that they can register with a gynecologist not only during gynecology but also with a midwife or family doctor.
There are also gynecological practices where the midwife works side by side – a doctor consulted the woman, for example, about the results of tests and complaints, but more about health during waiting and preparation for childbirth – the midwife.
Also, if a woman is registered with a midwife, ultrasonography is performed by a pregnant woman as often as necessary.
Although not all doctors and midwives and their work style can be the same, a visit to a midwife is often longer, such as half an hour or an hour, and it can be important for the expectant mother to get the much-needed peace.
Experts from the World Health Organization recommend increasing the number of midwives to improve maternal and newborn outcomes, reduce unnecessary interventions and achieve cost savings.
A completely undervalued resource is the midwife in the postpartum period.
For example, there are countries where midwives also go on post-natal home visits to take care not only of their mother’s physical but, last but not least, their emotional health.
“Midwife” means “to be with a woman”
That is why midwives in the world are talking more and more about the need to really coexist – to have more midwives in the world, to have their profession protected, so that midwives can work not only in a technocratic model of care.
Where midwives are allowed to take full responsibility for physiological childbirth, not just under the supervision of doctors.
A woman is at the heart of the midwifery care model. In this model, a woman is the one who gives birth, not the subject of childbirth.
The model of midwifery care recognizes the unity of mind and body and values a woman’s power to create new life. In it, pregnancy and childbirth are perceived as essentially healthy processes and mother and baby as a whole.
According to this model, a woman’s emotions have a big impact on the baby’s health. If the mother’s emotional needs are met, the child is also less at risk.
Prenatal visits are usually longer in this model and allow much more questions to be answered than in the medical model.
Studies show that in the midwifery care model, 85-95% of physically healthy women will give birth to their baby safely without surgery or the use of instruments such as birthing pens or vacuum pumps.
Medical intervention does not fit into the midwifery model unless it is really needed.
Childbirth has its own rhythm, so no one expects it to end within a strict time frame. Childbirth may begin and then stop, accelerate or slow down, and it will still be a normal birth.
Of course, the midwifery care model assumes that sometimes medical intervention is necessary, and then we must provide it. We emphasize that medical intervention can be harmful if used only for convenience or profit.
Help to give birth the way a woman wants
We most grateful should be for the freedom they give us – the freedom to be myself in all its forms in childbirth, to feel my body, to have a baby, to choose how to give birth, to be undisturbed when needed, and encouraged when needed.
This is when you can feel their upliftment after childbirth – when you are undisturbed and encouraging to climb your childbirth mountain.
Freedom is also to give a woman the opportunity to stop when she wants to stop, for example, by choosing anesthesia – to accept women’s different choices.