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From: [e-mail] (Pat Sonnenstuhl)
Newsgroups: sci.med.midwifery,sci.med.nursing,misc.kids.pregnancy,misc.answers,sci.answers,news.answers
Subject: Midwifery: Introduction
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Summary: This posting is an introductory posting about
        midwifery worldwide for sci.med.midwifery. Additional
        postings will describe midwifery in specific
        geographical areas.
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Archive-name: medicine/midwifery/intro
Posting-Frequency: monthly
Version: 0.02
Last Modified: 1996/6/8

The topics addressed in this document are:

1.  WHAT IS MIDWIFERY?
2.  WHAT DO MIDWIVES DO?
3.  HOW DO I BECOME A MIDWIFE?
4.  WHERE DO I FIND A MIDWIFE?
5.  IS MIDWIFERY CARE SAFE?

1.  WHAT IS MIDWIFERY?

The simplest definition of midwifery is "with woman", but truly,
midwifery means different things to different people. For many,
the Midwifery Model is an attitude about women and how pregnancy and
birth occur, and view that pregnancy and birth are normal events until
proven otherwise. It is an attitude of giving and sharing information,
of empowerment, and of respecting the right of a woman and her family to
determine their own care.

The attitude of midwifery, or the Midwifery Model can be contrasted with
the Medical Model. In general, the Medical Model is an attitude that
there is potential pathology in any given situation, and that medicine
can assist to improve the situation. Medicine is also about teaching,
informing, and prevention, but the power seems to be more with the
provider rather than with the woman.

Historically, midwives have always been around to help women give birth.
Before physicians, midwives were the primary healers in their
communities. They were the medicine women of their own cultures, and
assisted families and women throughout their lives. In the Old Testament
they were described as examples of the strength and faith in God.

Midwives were once the nutritionists, herbalists, doctors, ministers,
counselors all rolled into one 'profession'. Many feel they were the
first holistic practitioners. Midwives were always available to help
the poor, the women without medical care or the women who were the
outcasts of their culture. Today, midwives take care of anyone who
wishes to see them, but practice within the constraints of their medical
and legal systems.

Today midwives are as diverse as the populations they serve. Midwives
are willing to take care of anyone who wishes to see them. Over 70% of
births in the world are attended by midwives. In the Netherlands,
midwives deliver a majority of the babies. Other countries do not
utilize midwives to their fullest potential. Each country worldwide has
a slightly different view of midwifery, and of how midwives work within
their communities. In sci.med.midwifery, midwives will speak from these
various perspectives and cultures. Midwives are encouraged to share
their statistics and work situations within this newsgroup.

The World Health Organization (WHO) presents us with the following
definition of the midwife:

A midwife is a person who, having been regularly admitted to a midwifery
educational programme, duly recognized in the country in which it is
located, has successfully completed the prescribed course of studies in
midwifery and has acquired the requisite qualifications to be registered
and/or legally licensed to practice midwifery.
                                             (WHO, FIGO, ICM Statement)

2.  WHAT DO MIDWIVES DO?

Midwives teach, educate and empower women to take control of their own
health care. In most communities, they provide prenatal care, or
supervision of the pregnancy, and then assist the mother to give birth.
They manage the birth, and guard the woman and her newborn in the
postpartum period.

Most midwives encourage and monitor women throughout their labor with
techniques to improve the labor and birth. Reassurance, positive imaging
and suggestions to change positions and walk helps labors progress. Many
midwives provide family planning services and routine women's health
examinations such as pap smears and physical examinations.

They teach women about sexually transmitted infections, and focus on
prevention of the spread of infections. What specifically midwives do
will depend upon: her training, her licensure, and what is allowed in
the state, province, or country in which she practices.

For example, in the United States some midwives can prescribe
medications, provide women's health care throughout the menopause years.
Midwives worldwide attend births in the home, hospital or birthing
center, depending upon their education and licensure, and the rules
governing their practice.

Midwives believe it is especially important to provide time for
questions, teaching, and time to listen to the concerns and needs of the
women they care for.

The WHO definition of the midwife gives us the following guidelines
about what midwives do:

She must be able to give the necessary supervision, care and advice to
women during pregnancy, labour and the postpartum period, to conduct
deliveries on her own responsibility and to care for the newborn and the
infant. This care includes preventative measures, the detection of
abnormal conditions in mother and child, the procurement of medical
assistance and the execution of emergency measures in the absence of
medical help. She has an important task in health counseling and
education, not only for the woman, but also within the family and the
community. The work should involve antenatal education and preparation
for parenthood and extends to certain areas of gynecology, family
planning and child care. She may practice in hospitals, clinics, health
units, domiciliary conditions of in any other service.
                                            (WHO, FIGO, ICM Statement).

3.  HOW DO I BECOME A MIDWIFE?

There are many different paths to becoming a midwife.

Which path you choose will depend on many factors: where you live, what
the rules and regulations are in your state or country which govern
midwives, your age and education, and what sorts of experiences you have
had with birthing. The most important thing is that you need to look at
your reasons for wanting to become a midwife are, both short term and
long term. This will help you determine which path is best for you. The
resource published by Midwifery Today Getting an Education: Paths to
Becoming a Midwife gives good guidance and information about the various
paths to becoming a midwife. In some areas women start as childbirth
educators and/or doulas to become exposed to birth and working with
pregnant women.

4.   WHERE DO I FIND A MIDWIFE?

Seek midwives in your community, state and country of province. Speak
with local childbirth educators about midwives they know, and of course,
talk with your friends about their birth experiences and their
particular choice of provider. Watch for health fairs in your area,
check with herb and health food stores and ask questions of other types
of health providers such as massage therapists.

Sometimes a call to the local hospital or health center will give you
information about midwives, childbirth educators and doulas. Some
systems have referral systems for midwives in place, and you can easily
locate a midwife. In other areas you may need to ask lots of questions.
Locate your La Leche League or other groups that work with mothers and
infants, and ask for names of midwives they know. There might be a
listing within your phone book for midwives, but some midwives are not
listed there due to finances or legalities. For example, in the US,
sometimes only CNMs are found in the yellow pages and it might be more
difficult to find the names of midwives who attend homebirths.

Contact nurse practitioners in your area, your local Health Department
and Planned Parenthood. They will usually tell you their favorite
providers first.

5.  IS MIDWIFERY CARE SAFE?

As mentioned before, midwifery is probably the oldest profession known
to humankind. Certain mammals (whales for example) have been seen
assisting their sisters births, and helping new whales reach the surface
of the water, and are called midwives. The more the scientific method is
used to analyze birth and the use of technology, the more the midwifery
model stands out at a model for normal pregnancy and birth. Two recently
published works support non-intervention and midwifery care as being
safe and cost effective.

"A Guide to Effective Care in Pregnancy and Childbirth" is a
collaborative effort to prepare, maintain and disseminate reviews of
randomized trials of health care using the Cochrane Database. This is an
international effort, and a very readable resource.

The Database is based on a decade-long study of controlled trials in
obstetric care concerning different aspects of care and treatment. It
also describes the approaches and decisions that have been demonstrated
effective and those for which the evidence in inconclusive or negative.

"As technical advances became more complex, care has come to be
increasingly controlled by, if not carried out by, specialist
obstetricians. The benefits of this trend can be seriously challenged.
Direct comparisons of care given by a qualified midwife with medical
backup with medical or shared care show that midwifery care was
associated with a reduction in a range of adverse psychosocial outcomes
in pregnancy, and with reductions in the use of acceleration of labor,
regional analgesia/anesthesia, operative vaginal delivery, and
episiotomy." (p 15)

BIRTH: Issues in Perinatal Care Vol:22, No 2: June 1995 summarizes this
resource.

A second excellent resource is "Obstetric Myths Versus Research
Realities". This lists many recent abstracts from medical research in an
organized and systematic fashion.

It would be impossible to quote them, and one needs to review this text
to appreciate its value.

Women seeking assistance for her pregnancy and birth will find providers
at all points along the spectrum: physicians that are highly
interventive, physicians that behave similarly to midwives that are non-
interventive, trusting herbs and other modalities, and midwives that
practice like physicians. The onus is on the woman and her family to
question the available providers and find the match that best suits her
individual needs.

Please also see the following additional documents
describing midwifery in specific areas:

BIBLIOGRAPHY OF BOOKS AND RESOURCES ABOUT THE PROFESSION OF MIDWIFERY
MIDWIFERY IN AUSTRALIA
MIDWIFERY IN CANADA
MIDWIFERY IN FLANDERS (in development)
MIDWIFERY IN THE UNITED KINGDOM (in development)
MIDWIFERY IN THE UNITED STATES

************************************************************

This FAQ was prepared by Pat Sonnenstuhl, ARNP, CNM, RH <[e-mail]>
with the supportive assistance of the following contributors.

Suggestions for topics to add to the FAQ are always welcome.

Ms. Sabrina Cuddy <[e-mail]>:
Childbirth educator, Nursing Mother's Council volunteer, USA

Ms. Elizabeth Couch <[e-mail]>:
DEM, USA.

Ms. Marjorie A. Dacko <[e-mail]>:
Home birth and birthing clinic practice. President of the Nevada
Midwives Association.

Ms. Sharon K. Evans <[e-mail]>:
Writer and and licensed DEM, birth center practice. Co-chair for the
NARM Qualified Evalator Committee.

Ms. Cheri Van Hoover <[e-mail]>:
CNM, hospital practice, USA.

Mr. Patrick Hublou <[e-mail]>:
Midwife, Flanders, Belgium

Ms. Deirdre E.E.A. Joukes <[e-mail]>:
Consumers-viewpoint, The Netherlands

Ms. Debbie Pulley <[e-mail]>:
MANA Legislative Chair CPM, homebirth practice, USA

Pat Sonnenstuhl, ARNP,CNM, RH <[e-mail]> has been an RN since
1965, and CNM since 1981. She became interested in midwifery in the
1970's when it began to flourish again in California and has practiced
midwifery in the home, birth centers and hospitals.
She is the the Internet spokesperson for a combination CNM-Licensed
Midwife group in Washington State called the Midwives Association of
Washington State (MAWS).
She supports safe birthing with qualified practitioners and encourages
empowerment and self-knowledge for women.
She recently completed the intermediate level of training to became a
registered hypnotherpaist and uses hypnosis in a variety of ways in her
practice of midwifery.

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