Midwifery Resource Page

Midwifery Resource Page

Sep 06

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Original Link

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MIDWIFERY IN THE U.S.
By Geradine Simkins, President, and Interim Executive Director, Midwives Alliance of North America (MANA)
Mothering Magazine
May 3, 2011

Original Link

This article is excerpted from “Into These Hands: Wisdom from Midwives.” Published by Spirituality & Health Books, April 2011.

Every new member of the human family arrives on Earth through the body of a woman. Each day on our planet, the majority of babies emerge from the waters of their mother’s womb into the hands of a midwife. Since the dawn of time, midwives have been receiving the generations into their hands. Almost without exception, midwives exist in every culture, in every country.

Midwifery may well be the oldest healing profession known to humans. The word “midwife,” derived from old English, means “with woman.” In French the word for midwife, sage femme, means “wise woman.” The Danish word for midwife, jordmoder, means “earth mother” and the Icelandic word, ljosmodir, means “mother of light.” In most cultures midwives have enjoyed a place of honor, respected for their remarkable skills, wisdom and prowess as healers. Yet in the United States midwives are as endangered as the spotted owl or the gray wolf. And like these animals, midwives face significant threats to their way of life.

The United States is one of the few countries in the modern world to have ever outlawed midwives. In 1923 there were about 60,000 midwives practicing in the United States. By the 1960s traditional midwives were all but extinct. Slowly midwives have been making a comeback, but it has not been easy. Today there are roughly 8,000-10,000 practicing midwives.

Women’s Work

Historically birth has been a social event in which, for the most part, only women participated. In the early 1900s nearly all births in the United States (over 95%) were attended by midwives in women’s homes. While birth at home remained the norm even when doctors first began attending births, hospital birth soon became a fashionable status symbol for the middle and upper classes. By 1939 half of all American babies were born in hospitals and by 1970 that rate rose to ninety-nine percent.

Unlike the development of maternity care in Europe in the 1900s where male obstetrics and female midwifery developed side by side as compliments to one another, in the U.S. childbirth was marked by the rise of obstetrics and the fall of midwifery and turf wars that persist to this day.

A Captive Audience

With over three-quarters of all American women becoming mothers and over 4.3 million births in the United States each year, it is fair to say that maternity care affects large numbers of women and families. More babies were born in the United States in 2007 than ever before — about 15,000 more than the peak year of the Baby Boom.

At least eighty-five percent of all women in the U.S. enter labor at low-risk for problems. Nonetheless, in a recent national survey women reported that they received at least seven to ten obstetrical interventions, whether or not they needed them, or were given full disclosure about them, and regardless of the scientific efficacy of the interventions. Forty-one percent indicated that their caregiver tried to induce their labor, and fifty-five percent were given a synthetic hormone to strengthen or speed up labor contractions. Close to ninety percent of all women received spinal or epidural analgesia and/or narcotics in labor for pain management.

Use of narcotics can adversely affect mothers and their babies while non-drug therapies that are not dangerous are underused or ignored. Ninety-four percent of women were subjected to continuous fetal monitoring in spite of conclusive evidence that indicates it does not improve outcomes in either low-risk or high-risk women and definitely limits a woman’s freedom of movement in labor and birth. And at the same time almost sixty-percent of women who wanted a VBAC (vaginal birth after cesarean) were denied that option.

While the United States has the highest per capita spending on health care in the world, this has not led to optimal outcomes. The U.S. has one of the highest infant mortality rates in the modern world, ranking about thirtieth among developed nations, and the rate is higher for infants of color. Although the U.S. maternal mortality rate has improved over the past century, it has not improved at all since 1982 and appears to be increasing. Our maternal mortality rate is as dismal as some developing nations and the rate is higher for women of color. The safety, reliability, price and performance of our current maternity care system are issues of grave concern.

The Delivery Business

The common mainstream belief is that the safest place for birthing mothers and infants is in a hospital under the management of an obstetrician. While this perception has persisted since the early 1900s and has become the dominant American viewpoint, it is neither factual nor supported by research. Low-risk women and infants who are under the care of midwives, regardless of the site of birth, have similar outcomes to low-risk women and infants who are under the care of obstetricians in hospitals.

If you were to ask a group of people to identify the most common reason for hospitalization and the most common surgical procedure in the U.S., they would probably think in terms of acute illnesses, serious accidents or chronic diseases. But they would be wrong. The most common reason for hospitalization in the United States is childbirth.

Cesarean section is the most frequently performed surgical procedure in the U.S. reaching an all-time high of 32.8% of all births in 2009 with rates rising annually. Of the most common hospital procedures, six out of fifteen involve childbirth. The use of obstetrical procedures has doubled in the past fifteen years. Annually, one-quarter of all hospital discharges are for mother-baby healthcare related to childbirth.

Let me be clear: the problem is not that we have obstetrical practices available that can be useful in certain necessary or life-saving situations. The problem is that they are broadly applied to a population — pregnant women — that is basically healthy without concern for necessity or efficacy. In a national survey women reported that obstetrical interventions had been imposed on them without appropriate and timely discussions about the risks, benefits and alternatives and in some cases without their consent.

In short, our maternity care system is profit-driven rather than driven by consumer choice or the best research evidence about childbirth practices. In light of this, it is clear why midwives — who espouse a low-tech, high-caring model, and have the evidence to prove that the midwifery model is safe, satisfying, cost-effective and produces optimal outcomes, have become a threat to a system that advocates a costly high-tech biomedical model of childbirth. It is also clear why organized medicine is dedicated to discrediting the merits of the midwifery model, even seeking to eradicate midwives from the menu of choices for women seeking maternity care.

The Model Matters

For women who want an alternative to a highly medicalized model of birth, who believe that birth is a natural physiological process and even a celebratory event, choices are often unavailable. Normal birth that begins, proceeds and concludes as nature designed it is so rare that most maternity care providers have never seen it, most resident doctors have not been trained to accommodate it, and most women have to go outside the hospital to find an experienced care provider if they choose it. Therefore, women who want to have a natural birth often choose their own home or a birth center. Fortunately, women have excellent choices in numerous areas of this country, but certainly not everywhere. And if you are a poor woman in America, your choices are even more limited and dependent upon what services and providers Medicaid will reimburse.

According to Davis-Floyd the United States and Canada are the only two industrialized nations where professional midwives do not attend the majority of births and where midwives are not fully integrated into the system of care. Throughout the 20th century while America eliminated midwives, Europe generated them. Today in most of Europe the midwifery model coexists with the medical model, customers seem quite satisfied, healthcare delivery is less costly and perinatal outcomes are better than in the United States. For example, Dutch midwives attend about forty percent of all births, Danish midwives attend nearly all normal births, and Swedish midwives care for about eighty percent of all pregnant women and attend all normal births.

Modern Day Heroines

Midwives in the US have an awareness of their place in history and the unique roles they are playing in shaping it. They exemplify the indomitable spirit of consummate revolutionaries. But these midwives are not simply revolutionaries; they hold a vision for an overhaul of the healthcare system. They have generated new ideas, envisioned new paradigms and invented new systems in order to create change.

Midwives work to return birth to the domain of women, put average citizens in charge of family health decisions, replace unnecessary healthcare spending with cost-effective alternatives, utilize evidence-based protocols and practices, and restore normalcy to childbirth. They work to ensure that transformation occurs within a social justice framework so that all people can experience benefits of the system. Most importantly, these midwives form partnerships with women to assist them in discovering and recovering trust in their bodies and faith in the natural processes of pregnancy, birth, breastfeeding, mother-infant attachment and parenting.

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MOVIES:

The Face of Birth

The Face of Birth website
The Face of Birth on Facebook
The Face of Birth on Twitter
The Face of Birth on YouTube

Through the diverse and moving stories of five women who choose to birth at home The Face of Birth gives us the big-picture on the importance of how, where and with whom we give birth to our children. Featuring interviews with some of the world’s top childbirth experts The Face of Birth explores the links between choice and safety, and exposes the hidden costs, and broader social consequences of rising rates of intervention. A must-see for all parents, and anyone intending to give birth, this feature-length film will change the way you view childbirth.

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Birth Story: Ina May Gaskin and The Farm Midwives

Birth Story website
Birth Story on Facebook
Birth Story on Twitter

• The Farm Midwives
• Ian May Website

The feature-length documentary Birth Story: Ina May Gaskin and The Farm Midwives tells the story of counterculture heroine Ina May Gaskin and her spirited friends, who began delivering each other’s babies in 1970, on a caravan of hippie school buses, headed to a patch of rural Tennessee land. With Ina May as their leader, the women taught themselves midwifery from the ground up, and, with their families, founded an entirely communal, agricultural society called The Farm. They grew their own food, built their own houses, published their own books, and, as word of their social experiment spread, created a model of care for women and babies that changed a generation’s approach to childbirth. Forty years ago Ina May led the charge away from isolated hospital birthing rooms, where husbands were not allowed and mandatory forceps deliveries were the norm. Today, as nearly one third of all US babies are born via C-section, she fights to preserve her community’s hard-won knowledge. With incredible access to the midwives’ archival video collection, the film not only captures the unique sisterhood at The Farm Clinic — from its heyday into the present — but shows childbirth the way most people have never seen it — unadorned, unabashed, and awe-inspiring.

http://www.youtube.com/watch?v=doXpyxbSZFs

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MIDWIFERY ORGANIZATIONS:

American College of Nurse Midwives (ACNM)
Facebook Page
8403 Colesville Rd Suite 1550
Silver spring, MD 20910
240-485-1800

Citizens for Midwifery (CfM)
Facebook Page
PO Box 82227
Athens GA 30608-2227
888-236-4880

Foundation for the Advancement of Midwifery, Inc. (FAM)
Facebook Page
2020 Pennsylvania Ave NW
Box 720
Washington DC 20006
877-594-9996

International Center for Traditional Childbearing (ICTC)
Facebook Page
2823 N Portland Blvd
Portland OR 97217
503-460-9324

Midwifery Education Accreditation Council (MEAC)
PO Box 984 La Conner, WA 98257
info@meacschools.org
360-466-2080 (phone)
480-907-2936 (fax)

Midwives Alliance of North America (MANA)
Facebook Page
611 Pennsylvania Ave SE
Washington, DC 20003-4303
888-923-MANA

National Association of Certified Professional Midwives (NACPM)
Facebook Page
243 Banning Road
Putney VT 05346
800-704-9844

North American Registry of Midwives (NARM)
Facebook Page
5257 Rosestone Dr.
Lilburn, GA 30047

American Midwifery Certification Board, Inc. (AMCB)
Facebook Page
849 International Drive, Suite 120
Linthicum, Maryland 21090

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GENERAL RESOURCES:

Comparison of Certified Nurse-Midwives, Certified Midwives, and Certified Professional Midwives (pdf)

Mothering Magazine Special Report: Homebirth

Find A Midwife (searchable index provided by Mothers Naturally)

Wikipedia on Midwifery

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WEBSITES, MAGAZINES, PERIODICALS:

Mothering Magazine
Kindred
• Mothers Naturally
Midwifery Today Magazine
British Journal of Midwifery

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BOOKS:

Spiritual Midwifery by Ina May Gaskin
Ina May’s Guide to Childbirth by Ina May Gaskin
Birth Matters: A Midwife’s Manifesta by Ina May Gaskin

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ARIZONA MIDWIFERY RESOURCES:

Arizona Midwives
Arizona Association of Midwives
Arizona Student Midwives

Midwives Rising!
Nurturing Hearts Birth Services
Womancare Midwifery
Blossom Birth & Wellness Center
Beyond Conception Midwifery
Mary The Midwife
• Stephanie Purinton, Midwife

Midwife Programs & Licensing In Arizona

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2 comments

  1. Hello, I really loved watching all those videos assembled on your page. I also had a very beautiful pregnancy and birth experience and have become a great advocate for “connected” pregnancies and births – which are full of love and awareness. I am now making a film about the Dutch approach to pregnancies and birth – and we have recently launched a campaign to raise some funding for this project – perhaps something you would also find interesting to share with all the beautiful moms and dads who like this page… here is the link, if you are interested! Thanks: http://www.indiegogo.com/projects/the-beauty-of-birth/x/5917909
    Best wishes, Zhenya Starkova

  2. Good luck with your film, Zhenya. I’ll help spread the word…

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