Interview question #1

Your Title:          Licensed Midwife,
            Executive Director, American College of Community Midwives
            State Chapter California College of Midwives

I'm a mother of 3, grandmother of 2, former labor & delivery room nurse, childbirth educator, licensed community midwife, people farmer, licensed hang glider pilot and aspiring student of the harp.

I was a nurse in the L&D room of a busy urban hospital from 1961 to 1975, was a domestic Peace Corps worker in rural North Carolina from 1976-79 and have been a practicing midwife since 1981. I am a long-time birth activist, member of the Coalition for the Improvement of Maternity Care (CIMS) and ratifier of "Mother-Friendly Childbirth Initiative", developed and promoted by CIMS. I am an academic researcher on the history of midwifery and medical politics. Presently I represent the legal and legislative interests of California licensed midwives with the Medical Board of California.

1) Published essay entitled "The Official Plan to Eliminate the Midwives 1900 to 1999", in "Liberty for Women"
2) Editor/author of the California College of Midwives Standard of Care for community-based midwives
3) Web developer for www.collegeofmidwives.org; and www.ScienceBasedBirth.com

The historical definition of midwifery is the care of healthy childbearing women and their babies during the normal events of pregnancy, physiological childbearing, breastfeeding and the period of early parenting. The term 'midwifery' is correctly applied to the activities of caregivers engaged in providing normal maternity services during the spontaneous events of physiological childbearing, regardless of the educational background or status of the practitioner.

Midwifery is not a practice of medicine but a separate discipline arising in response to the physical, psychological and social needs of healthy childbearing women and their newborns. It is predicated on the expectation of normalcy, a respect for and trust of physiological process, and a non-interventive style which depends on specific skills and social support for the spontaneous biology of birth. This definition is to distinguish the maternity care of normal, healthy mothers -- including palliative treatment of minor deviations and the capacity for emergency-response by the practitioner -- from the hospital-based, high-technology practice of obstetrics which is a surgical specialty that addresses the diseases, dysfunction and disabilities of reproduction and fertility.

The modern-day professional midwife is a trained and experienced professional who provides care to healthy women for pregnancy, childbirth, immediate postpartum / postnatal and also well-woman gynecology care. Birth services by professional midwives may be in hospitals, independent birth centers and in the family’s own home. Some midwives also offer friendly psychological support for new mothers/babies postpartum – with additional visits scheduled at 3, 6 and 9 months.

Women with a serious medical condition or complicated pregnancy will need obstetrical care during pregnancy and hospitalization for childbirth. However, some midwives also provide labor support services and patient advocacy to women with obstetrical needs and those who want a hospital labor and birth under obstetrician care.

Licensed midwives (LMs) and some certified nurse midwives (CNMs) offer home-based services to essentially normal healthy women enjoying a normal pregnancy who plan to labor at home and, assuming (a) continued good health of mother and baby and (b) normal spontaneous progress without complications, give birth at home. Standard, community-based midwifery care includes non-interventive management of pregnancy, labor, birth, postpartum and the neonatal period.

Who is she? (personally, don’t think this question is useful) The majority of midwives are women, they are more likely to be married and have children themselves but like the rest of the population, midwives come from all social and educational backgrounds, political persuasions and lifestyles.

Maternity care for healthy women experiencing normal pregnancies is based on the fact that pregnancy and birth are normal healthy biological processes that do not routinely benefit from the use of drugs or surgery.

The midwifery model is based on traditional principles that have been proven successful throughout the history of our species. The technical word for this type of care is ‘physiological management’, which describe care that is "in accord with, or characteristic of, the normal functioning of a living organism”. Physiological management is the science-based model of normal maternity care and standard for all healthy women with normal pregnancies, regardless of the setting for labor and birth (home or hospital).

This woman-centered model of care has been proven to reduce the incidence of birth injury, physical and emotional trauma and cesarean sections.

Principles of Midwifery Practice: A professional midwife engages in an ongoing process of risk assessment that begins during the initial visit and continues through the completion of care after the baby is born. This includes risk prevention, risk reduction and referral or transfer of care to a physician or medical facility whenever medically necessary or at the mother’s request, anytime during pregnancy, labor, birth or postpartum.

The midwifery model of care respects the autonomy of the mentally competent adult woman and acknowledges the healthy woman as the primary decision maker throughout her childbearing experience. It is the mother's right to make informed choices about the manner and circumstance of normal pregnancy and childbirth. It is the midwife’s job to provide complete, relevant, objective information in a non-authoritarian and supportive manner. The midwife is also responsible for continually assessing safety considerations and the risks to mother and baby and informing the client of identified risks

How does this differ from that of a Medical Doctor? Midwives believe that pregnancy and childbirth in healthy women are normal biological processes that do not benefit from the routine use of medical interventions and that such interventions increase the risk of complications. Midwives see their role as supporting healthy women (70% of all childbearing women) socially, psychologically and physically during labor and birth, while reserving medical and surgical interventions for complications and emergency situations only.

In contrast, the conventional practice of obstetrics, when applied to the 70% of healthy women, is associated with a high level of planned or ‘routine’ medical interventions, such as induction of labor and operative delivery. Physiological management is considered by the medical profession to be an old-fashioned or “substandard” form of care. Obstetrical management of labor for healthy women is associated with a higher rate of complications for both mother and baby, a much higher anesthetic use and increased rates instrumental deliveries and Cesarean surgery.

Unfortunately, cesarean section has many more complications, including ones that do not show up until much later. The immediate post-operative complications of Cesarean surgery include hemorrhage, blood transfusions, emergency hysterectomy, infection and blood clots that go to the lungs. Delayed complications of C-section include secondary infertility, tubal pregnancy and miscarriage, PTSD and lower rates of breastfeeding. Downstream complications in future pregnancies include placental abnormalities, stillbirth, uterine rupture, emergency hysterectomy, blood transfusions and increased asthma in babies born by cesarean section, both in childhood and as an adult.

The World Health Organization, which publishes criteria for management of normal pregnancy and birth, notes that obstetrical management for healthy women is neither safer or more cost-effective than physiological care by professional midwives and physicians.