Hello out there midwives and midwives to be in Internet land, I hope you've had a wonderful week. Welcome to this Midwife Motivation Monday. I've had an introspective time over the last 7 days, rounded off by listening to an interesting lecture recommended by an obstetrician friend.
This explains why I'm tackling the 'the role of a midwife' in this week's post.
I hope this week you've had some great outcomes for your women and families. We see women at their most vulnerable, most happy, most at risk, most in need of someone to listen. You offer things no other professional working in health care can and you should be proud of it. And that goes for you people working towards being midwives too!
So: the role of a midwife.
I've come across a few different definitions. A clinical definition is 'the healthcare professionals who care for women and their babies from the start of pregnancy, through childbirth, and into the postnatal period, with input from doctors when required'. But this barely touches on exactly why we're so important, and what we do differently from other healthcare professionals like obstetricians and nurses.
The lecture that was recommended to me this week is called 'An Apology for Obstetrics'.
It discusses American maternity care, in particular American obstetric mortality and morbidity stats. It also discusses midwives and their role. I was looking forward to a 'grand round' lecture as I listen to quite a few. But I had a few issues with it.
Firstly, American MD Dr Herrell, who wrote the lecture, doesn't mean 'apology' as 'sorry'. He means it in the 'classical' sense, which means a 'defense'. I don't mean to be hypercritical, but using little known classical terms seems to set a tone of willy-waving to me.
So perhaps Dr Herrell and I didn't get off on the best foot. But secondly, he seems to think the most extreme American midwifery philosophies apply to the rest of the world.
He uses words like 'neo-feminism'. And says midwives believe they must fight to 'replace the broken system' that is modern maternity care.
Thirdly, Dr Herrell seems to think midwifery philosophy is about removing women from the reach of obstetricians. Throughout the lecture, he suggests the role of a midwife in popular culture's eyes is to bring midwifery back to the 'good old days' of no intervention. You know, when women died from malpresentations and massive hemorrhages. Hurrah.
In truth the vast majority of midwives work to use the evidence base and research, and value hard science. It's only a tiny minority of midwives that think they're role is to wage a war against male intervention in birth.
It's not an entirely negative review of this lecture from me.
Dr Herrell presents some fascinating statistics suggesting the mortality and morbidity of America's obstetric care isn't nearly as bad as it's presented by the World Health Authority. It's interesting stuff and well worth a listen.
Dr Herrell also ends his lecture on the overall noble, though slightly alarming suggestion that obstetricians should no longer laugh at women coming in with a birth plan and tell them they're going to end up with a caesarean. So it's not all bad (!).
But to me, this lecture is a massive oversimplification of the problems raging in America and the role of a midwife. And it's not just Dr Herrell. Globally, the idea that midwives are all anti-establishment and anti-obstetrics has leaked everywhere. Dara O'Briain is even making jokes about midwives having a turf war with obstetricians.
No midwife I've worked with thinks obstetricians are 'masculine oppressors'. Our role isn't some kind of feminist fight over caring for women in my opinion. We continue to make sure care is empathetic and for the women, as opposed to just 'technologically and medically advanced'. We also make sure we don't throw the metaphorical baby out with the bath water as obstetrics moves on. A good example of this is delayed cord clamping.
As childbirth became medicalised, we started clamping cords ASAP when the baby was born. There's even this device called an 'Umbilicutter' available which lets you clamp and cut a cord one handed. But we now know that some (especially prem) babies get really damaged if you cut the cord straight away as it robs them of blood volume.
Historical midwives knew this. Historical obstetricians knew this. But somehow we've forgotten it, and had to do research to get the knowledge back, and it's taking a long time to re-implement this care.
But guess who's implementing it in my experience? It's the midwives.
For me, the role of a midwife is to bridge the gap between common sense, women centered care, and the tireless forward march of technology.
Historically in the rest of the world, apart from a few rocky moments, midwives and doctors have worked together, complementing each other's practice. The outcomes obstetricians get are impressive. But we all would prefer women to need no intervention at all, because it means everything has gone to plan. The outcomes midwives get are truly excellent, because no intervention has been necessary.
Anyway, I'd love to hear your thoughts on this. Is there anything else crucial to the role of a midwife I've missed out?
Please consider sharing this post around if you enjoyed it. I hope you have a wonderful week supporting the profession. Know that even when it doesn't feel like it you're valued, and your care and input for women and families is priceless.