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Informed Choice for Women
Part III:
Birth Attendants, Historical and Modern
by Mary Ceallaigh
The Tradition of Labor Companions
As in today's context, historical labor companions have ranged in personality, specialities, and
working style - and societal contexts have varied widely, also like today (North American birth culture
has cultural variations, and Western culture varies greatly between North America, Scandinavia, and
Europe). Sometimes women have had a choice of birth attendants, sometimes not.
A History of Birth Attendants
Women have given birth for millennia, usuallly attended by other women who have given birth
themselves and/or have helped other women during birth and in the arts of self-care.
The primary arts of the traditional non-medical labor companion, or midwife, were devoted nutritional
education, herbal wisdom, hygiene, physical mobility techniques, meditative practice & guidance for
the psyche of the laboring woman, and newborn parenting support. There have always been
traditional midwives in native and/or rural peasant cultures varying in their specific arts according to
cultural beliefs that were faith-based, and often involved meditations and prayer formulas. Traditional
birth attendants typically had longstanding social relationships with birthing women - often elderly
midwives had helped two generations or more in one family.
In flourishing agricultural peoples the world over, birth has overwhelmingly been embraced as a
healthy, unhindered journey of Life at its best. Traditional birth attendants have often been
supported by their communities, with esteem, housing provisions, and, often, leadership roles in old
age.
The involvement of men at births in early modern Europe began in royal households, when the odd
science of the time joined forces with butchers who had likely surgical tools. The allure of early
alchemical thought was often combined with a hodgepodge of blood-letting surgeries and
superstitious interventions, and was the appealing "new" medicine for various patriarchs of the time.
Royal wives, often being imported and isolated brides (many of whom spoke another language than
the local peasant midwives) were candidates for various of their spouses' "scientific" brothers, many
of them perishing in various phases of childbearing. Aristocratic ladies who instead
stayed in their homelands generally had much better outcomes as they were typically attended by
midwives and other ladies familiar to the family, from a lineage of service.
In malnourished lower class Europe of recent history, (as in present day famine/poverty zones the
world over) where pelvic bone deformities, anemia, and pelvic floor muscle malfunction was
common - birth was indeed a perilous journey that many of these women did not survive. Midwives in
those circumstances of social illness, without cesarean surgery options, often faced maternal mortality
and sick babies.
The advent of urban Western "hospitals" (of a sort) in the late 1700s, where cesareans were
performed, offered some new hope - however at a great price: well-meaning butcher-obstetricians of
the time (formal medical schools only began in the early 1800s) did not follow hygienic technique and
did not wash their hands in between examining patients, thus spreading rampant infection (the
infamous "childbed/puerperal fever" often erroneously assumed to be homebirth-related) in indigent
maternity wards as well as upper class wings where privileged women had been convinced to try the
"modern" setting.
In the 1850s, Drs. Simpson (Scotland) and Seimmelweiss (Austria), in separate inquiries,determined
the iatrogenic (doctor-caused disease) roots of the rampant puerperal fever and immediately
instituted strict hand-washing in their regional hospitals, with immediate and drastic improvement of
mother & baby survival rates. In the decade following, hospitals in all the major cities in the Western
world followed suit in their maternity wards. They also decided to implement hospital-wide hygiene
standards, improving the survival of many other people - God bless Simpson and Seimmelwiess!
In contrast to the lack of wisdom in western urban health history, in the pre-colonized Native American
context as well as the Eastern world, traditional midwives and the medicines of traditional Africa, India,
and Asia often had unique and effective hygienic practices such as usage of antimicrobial herbs,
practitioner purification rituals, and/or non-invasive protocols. Likewise, in ancient Greece there was
extensive knowledge and practice of hand-washing and general hygiene - they even had a Goddess
named Hygieia.
Vocations and Careers:
The Spiritual Midwife, The State Midwife
The history of traditional midwifery in the western world is quite a fascinating one as documented by
the social historian Hilary Marland in the extensive scholarly text The Art of Midwifery: Early Modern
Midwives in Europe (Routledge,1993). Another well-researched text that contributes to this realm is
the must-read classic Nurses, Witches, and Midwives: A History of Women Healers by Barbara
Ehrenreich (Feminist Press, 1972).
Historically, whenever midwives have given themselves over to church or state law, there has been a
subsequent period of flourishing for a select group of a few 'registered' midwives who practice
according to the interests of the prevailing authorities, and a marginalizing of those who do not, many
of them traditional healers. The 'interests' of these authorities were costly tax & registration payments
(in the case of government mafias) or the carrying out of baptismal mandates or extracting of secret
details from unwed mothers for public shaming (in the case of early Vatican law). Modern interests in
today's context would be likewise costly licensing & taxes, as well as competition for healthy pregnant
clients between hospital and non-hospital based practitioners.
Each period of a flourishing midwifery elite in western culture has directly been followed by a period of
widespread social backlash and punitive legislation when the tides of prevailing authorities and social
liaisons would change - as they always do - ushering in imprisonments, and various restrictions
diminishing all midwifery (not unlike the current American context where several licensed and
unlicensed midwives in most states have been legally harassed and/or imprisoned and where CNMs
are finding it more difficult to sustain a home or hospital practice). It is estimated that during Middle
and Late Europe hundreds of thousands of people were considered 'infidels' by various dominating
groups at the time and killed during the Inquisition as well as various wars - many traditional healers,
herbalists, and midwives being among them.
Upon the settlement of North America by the English and Dutch in New England, the rising authorities
of Puritan governing bodies ushered in new backlashes against traditional women's wisdom culture,
with the infamous Salem witch hunts among them, wherein any free-thinking & free-speaking person
who did not conform to or who threatened the religious order at the time was freely imprisoned and
executed.
Midwives and Male Healers
Traditional birth attendants from ancient tribal societies as well as more modern European or
American rural peasant/sharecropper communities would, on occasion, confer and collaborate with
men who were tribal healers or country physicians, when faced with an ill mother or an unresolved
complication.
Traditional midwives were keen observers of physiological signs & symptoms and monitored fetal
health by addressing the mother's intuitive process, and, more recently, by using wooden acoustic
listening devices (called Pinard horns) still used by Amish midwives, and later, fetoscopes, as did all
early physicians. Traditional midwives relied on maternal signs & symptoms and dialogue much more
than internal exams (doing very few, if any, vaginal exams in labor) did not practice surgeries such as
episiotomies, nor did they do venipuncture administration of fluids and drugs. Such practices would
have been considered the domain of doctors rather than the art of midwifery.
My own grandmother told me of her midwife mother's friendly relationship with their rural family doctor
who referred healthy farm ladies to her saying "You don't need me, you need Minnie Mae." Likewise,
my great-grandmother and the doctor had an understanding that she could alert him for conference
and/or assistance if ever she needed, and at least one time she did, with a positive outcome for al.
This legacy of positive inter-relationship between faith-based midwives and free-thinking male
physician-healers of the time existed in the rural Black south as well. Traditional "grand midwives"
were openly supported by a scattering of empathic physicians who recognized and properly esteemed
the quality care of rural midwives in a time when the burgeoning American
Medical Association (99% male at the time) was generally demeaning and/or seeking punition towards
non-medical birth attendants.
The growth of immigrant cities as well as rural migration brought potential clients to growing urban
hospitals and created a social trend whereby the new medical establishment began to "manage" many
births, even for healthy women.
Modern Birth Attendant Options for Healthy Women
Obstetricians
Obstetricians are the most common choice of maternity care provider and birth attendant in the US,
especially in situations where a pregnancy is considered “high risk”.
Although many obstetricians are becoming more supportive of a less aggressive and less invasive
approach to childbirth, there still seems to be a prevalent belief that childbirth is a condition that
needs to be managed, rather than a physiological process that, in most cases, will and should be
allowed to occur, empathically facilitated with little to no intervention. Likewise, prevention of illness
during pregnancy through nutritional education is rare with obstetricians, as they typically receive only
4-6 hours of nutrition class times, as compared to the hundreds of hours of apprenticeship, study,
and practice of midwives.
Obstetricians can vary greatly in philosophy and internship experience, and the vast majority of
obstetricians have never witnessed a homebirth or a waterbirth, nor have they been educated in the
appropriate use of birthing pool for pain management. There are exceptions to this rule, such as the
famous women's health advocate Christiane Northrup M.D. and Christine Sebastyn M.D. of Austin,
Texas.
Many if not most obstetricians have never witnessed a first-time mother (primipara) give birth without
drugs in the labor room. As obstetricians are primarily relied upon by hospitals for logistical
supervision and actual delivery of babies, most have never provided continuous emotional labor
support and coping guidance for a laboring woman - and frankly, the vast majority of modern
obstetricians do not consider labor support a requisite skill for them to master.
Being that the Latin word root of "obstetrics" is "to stand in front of or to obstruct" and that old
English's "midwife" means "with woman" it is not surprising that obstetrics is focused on a mastery that
depends on interventions as its forte. Taking that into consideration, it is important to interview a
potential obstetrician with candor and depth, which necessitates informed choice preparation on the
part of the pregnant woman. Unfortunately, many healthy pregnant women find it difficult to even
make serious inquiry of a potential obstetrician, due to inhibitions and the overwhelming cultural
imprint of doctors-as-experts! Many women simply go with the friendliest OB of what's available with
their insurance, or the referred doctor-associate of a fertility tech MD, or the obstetrician that an
acquaintance simply has described as "really nice" - for the most intimate and personal journey of
their lives.
Many healthy, "low-risk" women feel that an obstetrician can provide a higher quality of care, because
of their medical background, training and a perceived ability to handle complications and emergency
situations more effectively than a midwife. This is not necessarily the case, especially when you
consider the fact that conventional medical school education perpetuates the misconception that birth
is an inherently dangerous event and our babies need to be “evacuated” from our wombs as quickly
as possible by using "interventions as preventions". Conventional medical schools and their
textbooks are still promoting the paradigm of women laboring in a bed, if not completely on our backs,
and being managed by IV administrations. This creates a tendency to "over manage" birth, and
significantly increases the risk of further and serious complications to the mother-baby, including but
not limited to an increased risk for cesarean section.
General or Family Practitioners are an alternative to obstetricians, especially in Britain and Australia,
famous among them being the Australian Sarah Buckley M.D., prolific author and home birth mother
of four. They are trained to provide well- and preventive care and more family-oriented, and often
view birth as the more natural, family-centered event that it is. Many women who chose a general or
family practitioner as their maternity care provider and birth attended can be very satisfied with their
birth experiences and the more personal care provided by their family physician. Of course, even
though they may provide well-woman care, many American GPs do not provide maternity care or
attend births because of malpractice insurance issues as well as difficulty securing hospital privileges
due to the highly competitive nature of obstetrical interests promoted by the American College of
Obstetricians and Gynecologists.
Friendly questions to ask a potential OB:
Have you done further studies in nutrition? What is your nutritional philosophy for prenatal care?
Are you interested in pre & perinatal psychology?
What are the benefits of drug-free birth, as you see it?
About how many primaparas have you seen give birth without drugs? Multiparas?
Have you ever provided continuous labor support for a parturient woman?
Do you feel that Doulas are an asset for public health?
What's your current episiotomy rate? Is this rate decreasing in your practice?
Would you feel comfortable caring for me if I was walking around in labor?
Are you willing to adapt to my chosen birth position during second stage? What if I don't want to be up on the bed?
Would you be able to commit to being informed about my birthing intentions to the best of your ability?
As a healthy woman, I am birthing at a hospital for "just in case" reasons, would you be supportive of this approach?
Part of that minimal intervention is that I don't want my vulva cut in the event of possible tearing, are you prepared to do
perineal support or hot compresses? If not, can my Doula assist with this?
I would like to implement current knowledge about the benefits of immediate skin-to-skin reunion with my baby, even
in situations of surgery. Would you be able to commit to facilitating that for us?
Midwives: Medical and Traditional
The Midwifery Model of Care is based on the fact that pregnancy and birth are normal life events and
that philosophy is usually reflected in their approach to childbirth. Midwives tend to be conscientious
in helping a woman co-create her own birthing experience. Midwives dedicate more time and
attention to individual cases, typically spending an additional half hour of each prenatal appointment
discussing personal or nutrition matters beyond vital signs and lab tests.
Medical Midwives
CNMs: Certified Nurse-Midwives (CNM) are chosen as the primary attendant for a significant
percentage of US births in both freestanding birth centers and hospitals, often times in conjunction
with obstetric practices. A small number of CNMs practice as independent homebirth midwives.
CNMs are regular RNs with an additional year of training in midwifery. Client education is a major
theme in their practices.
CNMs are often restricted to some degree by the current obstetric model of care, and indeed their
general practice is discouraged by a portion of AMA-associated legislative and political bodies,
varying state by state. A CNM is oftentimes limited to provide maternity care for women who have had
“low risk” pregnancies (an ambiguous term that seems to eliminate most everyone these days) and
any situation involving possible complications would be referred to an obstetrician. Most CNMs have
never attended a homebirth and some may not have much experience or commitment towards
facilitating instinctive birth.
LMs or CPMs: Direct-Entry Licensed Midwives or Certified Professional Midwives are under the
jurisdiction of the state, and supervised by state medical or nursing boards. LMs/CPMs attend a
much smaller percentage of births in the US, in freestanding birth centers and in homes. Training for
a direct entry midwife varies depending on state licensing requirements, but usually involves an
extensive apprenticeship with an experienced midwife involving a variety of homebirth and sometimes
birth center scenarios, along with completing an academic formal midwife-training program.
LMs/CPMs tend to focus more on whole-body wellness (specifically nutrition and its impact on healthy
pregnancy and birth) and women's education. They often create more personal relationships with
clients due to smaller practices, dedicating more time and attention to each individual case, and
aspiring to establish emotional and physiological support to their clients for the pregnancy, birth and
postpartum.
LMs/CPMs do at least one prenatal home visit, and several postpartum home checkups in the first
days and first two weeks after birth. This is very attractive to women who are choosing intentional
confinement at home the first 40 days, greatly reducing potential stress on the new mother-baby who
are generally expected by OBs and CNMs to leave home and travel for office visits during this
supremely tender time. (OBs and most CNMs do not have practices that are designed to incorporate
any home visits, and will refuse to come to the home for early postpartum follow-ups, if
requested).
LMs also provide consistency in care, usually being the only care provider that their clients see during
their prenatal visits and who will attend their births – not the unpredictable “OB or CNM roulette” that
is found in so many hospitals and birth centers. This consistency provides a level of security that can
create a more positive and relaxed pregnancy and birth experience for women and families.
LMs/CPMs seek to help women successfully birth outside of the hospital and have chosen the
responsibilities various EMT medical tools and interventions in the name of home birth. These
medical practices, many of which can be refused by clients, include regular ultrasonic doppler checks
(some carry portable EFMs, and some others are willing to use fetoscopes or pinards if requested)
and may include amniotomy, IV antibiotics, oxygen administration, cutting of the vulva (episiotomy) in
5% of clients, suctioning and wrapping of baby before giving it to the mother, typical severance of
the cord before the birth of the placenta and/or within 10 minutes of birth, injections of pitocin in forth
stage, injection of lidocaine for suturing, newborn weighing and Vitamin K administration within the first
hour of birth, and PKU heel stick newborn tests.
Many medical midwifery practices have a large client load, with midwives' energy being spread thin
when there are back-to-back births and postpartum visits to accomplish. The lighter your medical
midwife's monthly schedule is, the more available her energies will be for authentic relationship with
you.
Friendly Questions to ask a potential Medical Midwife:
What sorts of settings have you attended births in? What is your current client load?
What happens if you have more than one client in labor?
Are you open to taking a low-tech approach? (fetoscope, minimal VEs, minimal interruptions)
Do you provide traditional labor support services throughout labor if needed? What sorts of activities might that entail?
If not, do you welcome Doulas?
Would you be comfortable supporting me in a birthing tub?
Are you comfortable supporting my committed partner to support me in private?
In the unexpected scenario of hospital transport, would you continue with me in a labor support capacity?
Will you do at least one prenatal home visit appointment? Are you supportive of a 40 Day postpartum intentional
confinement for healthy mother and baby?
Are you informed about extended-delayed cord severance and non-severance, do you ever facilitate Lotus Births?
Traditional Non-medical Midwives
Though common throughout rural North America in the first half of the 20th Century, Traditional
Midwifery has declined in recent years, as elderly "grand-midwives" have passed away and
apprenticeship options in the old arts of midwifery have become quite limited. Along with this has
been an aggressive social promotion of obstetric dependency for healthy low-risk women by the
American Medical Association, state lawmakers, and the mainstream media, much of it based in
misinformation and/or profiteering.
Subsequently, the arts of non-medical midwifery are rare to find and less openly promoted, though
still existent in some communities of various orthodox religious or spiritual sects (Amish, Hasidic
Jewish, Mormons and rural Christian-Patriots, and Spiritual Ecologists to name a few). Because of
current state control of "midwifery," any midwife who is paid to attend a birth can be arrested and
significantly harassed by ignorant civil servants and medical/nursing boards for any negative outcome
or complication, regardless of client support and understanding. As traditional midwives do not use
medical tools and do not perform episiotomy, rather than being charged with "practicing medicine
without a license" they are instead faced with scapegoating accusations of "negligence" if an
unresolvable maternal complication arises for rural hospital transport or a baby arrives with birth
defects.
As Robbie Davis Floyd Ph.D. (Birth as an American Rite of Passage) and Suzanne Arms (Immaculate
Deception) and Ricki Lake (Born in America) have documented in their birth industry research: 1)
maternal complications in otherwise healthy women happen consistently in the hospital, 2) maternal
mortality rates are deceptively accounted for as "Anesthesiology
complications, and 3) American hospital-based birthing care results in being only 27th on the WHO's
list of nation-state Infant Mortality prevention.
From a feminist perspective, the diminishment of the art of traditional midwifery in name of medical
midwifery and obstetrics for healthy women may certainly not be in the best interests of all women and
babies! For anyone who esteems their civil liberties and the pursuit of life, liberty, and happiness in
their own bedroom/home, this can create a personal dilemma when desiring traditional, non-medical
care for religious or informed-choice reasons as it can be very hard to find such a practitioner in the
current professional environment. There are some traditional midwives, such as Jeannine Parvati,
who stopped attending births altogether, instead focusing their midwifery skills on helping healthy
women prenatally prepare to be their own midwife for a planned freebirth.
Planned Freebirth
Freebirth, or planned unattended birthing is another option for healthy women who long for an
instinctive home birth in the manner that they conceived their baby, choosing this path out of
abundant options rather than out of lack of choice, or isolation. This birthing option has recently
received more media coverage, as the numbers of educated western birthing women who choose this
path has increased (1%-9% of the home birth community, depending on region, Australia being the
highest). Freebirth is different than emergency unattended birth, which is usually precipitous (very
fast) labor of a third, forth, or fifth child, often occurring in car or taxi on the way to a hospital!
Historical unattended births include that of Christ, and Mahatma Gandhi caught his third child without
a care provider present (because, unexpectedly, the white South African local midwife simply refused
to attend his wife, due to race).
It can be very helpful for most healthy, inquisitive pregnant women to meet with other women who
have had freebirths and hear their stories, or at least see a freebirth documentary film such as A
Clear Road to Birth. Incorporating freebirth into the spectrum of possibilities definitely empowers the
general courage of many women who are planning various attended birth scenarios, as it makes
attended unmedicated birth seem even easier!
Healthy women who choose freebirth feel deeply assisted by their own intuition as an inner midwife,
and have worked on developing this through their life experiences, previous birth experiences, and/or
yoga & meditation sadhana (daily practice). They have also done extensive preparation and
research (even before conception), and many of them have attended births as a midwife, doula, or
friend. Healthy women who choose freebirth feel it is an inherently natural, mammalian, event of
privacy and sexuality, not requiring the presence of a professional attendant.
Many freebirth mothers are not primaparas (first-time birthing women), they have a 'proven pelvis' and
have given birth at least once before. However, an estimated 20% of freebirth women are indeed
primaparas, the vast majority of them highly educated and well-prepared (though certainly not all -
some unattended laboring women are in the category of mentally ill, addicts, or nomadic
homelessness, but this article is not addressing those ladies, who are technically not of the healthy
freebirth orientation).
It is extremely important, when considering an unattended birth, to become very familiar with the
physiology or childbirth, preferably through attending births or doing extensive study and training.
The proper orientation for a healthy woman and her partner enables you to recognize subtle signs
and symptoms of possible complications and respond to them with loving stability and flexibility. Most
freebirth families are well-informed of their options and strategies in the unlikely event of healthcare
back-up, and have a well-defined emergency plan should they need hospital transport. Birth in a
healthy, fearless woman is as safe as Life gets. Yet there are no guarantees, at home or in a
hospital.
Part of freebirth preparation includes dealing with the highly unlikely but nevertheless possible reality
of complication or loss, which all women face, but which is most negatively judged when it occurs
within a freebirth intention situation. Complications are normative in the hospital environment,
however, there is little compassion for complications that occur in the unattended home environment,
due to cultural and family psychology. For freebirth mothers, this involves taking 100% responsibility
and being prepared to deal with any backlash among peers and state law should there be any
complication that fails to resolve. Transport to hospital for freebirth mothers during labor is often met
with alarm and negativity on the part of hospital admissions or emergency room staff. Therefore,
some freebirth mothers choose to be covered by obstetric or CNM prenatal care for 'just in case'
personal backup, upon which their conservative hospital transport involves less stress (though often
their previous care provider will be unavailable or unwilling to attend anyway).
Prepared freebirth women commonly report an expanded capacity for birth pleasure and ecstatic
birth. And, like all women, these women also report having intensely uncomfortable or painful and
challenging moments in labor! However, there is a markedly reduced incidence of unresolved
complications compared to attended, healthy parturient women, which is a subject of fascinating
discussion in the freebirth community.
Part III:
Birth Attendants, Historical and Modern
by Mary Ceallaigh
The Tradition of Labor Companions
As in today's context, historical labor companions have ranged in personality, specialities, and
working style - and societal contexts have varied widely, also like today (North American birth culture
has cultural variations, and Western culture varies greatly between North America, Scandinavia, and
Europe). Sometimes women have had a choice of birth attendants, sometimes not.
A History of Birth Attendants
Women have given birth for millennia, usuallly attended by other women who have given birth
themselves and/or have helped other women during birth and in the arts of self-care.
The primary arts of the traditional non-medical labor companion, or midwife, were devoted nutritional
education, herbal wisdom, hygiene, physical mobility techniques, meditative practice & guidance for
the psyche of the laboring woman, and newborn parenting support. There have always been
traditional midwives in native and/or rural peasant cultures varying in their specific arts according to
cultural beliefs that were faith-based, and often involved meditations and prayer formulas. Traditional
birth attendants typically had longstanding social relationships with birthing women - often elderly
midwives had helped two generations or more in one family.
In flourishing agricultural peoples the world over, birth has overwhelmingly been embraced as a
healthy, unhindered journey of Life at its best. Traditional birth attendants have often been
supported by their communities, with esteem, housing provisions, and, often, leadership roles in old
age.
The involvement of men at births in early modern Europe began in royal households, when the odd
science of the time joined forces with butchers who had likely surgical tools. The allure of early
alchemical thought was often combined with a hodgepodge of blood-letting surgeries and
superstitious interventions, and was the appealing "new" medicine for various patriarchs of the time.
Royal wives, often being imported and isolated brides (many of whom spoke another language than
the local peasant midwives) were candidates for various of their spouses' "scientific" brothers, many
of them perishing in various phases of childbearing. Aristocratic ladies who instead
stayed in their homelands generally had much better outcomes as they were typically attended by
midwives and other ladies familiar to the family, from a lineage of service.
In malnourished lower class Europe of recent history, (as in present day famine/poverty zones the
world over) where pelvic bone deformities, anemia, and pelvic floor muscle malfunction was
common - birth was indeed a perilous journey that many of these women did not survive. Midwives in
those circumstances of social illness, without cesarean surgery options, often faced maternal mortality
and sick babies.
The advent of urban Western "hospitals" (of a sort) in the late 1700s, where cesareans were
performed, offered some new hope - however at a great price: well-meaning butcher-obstetricians of
the time (formal medical schools only began in the early 1800s) did not follow hygienic technique and
did not wash their hands in between examining patients, thus spreading rampant infection (the
infamous "childbed/puerperal fever" often erroneously assumed to be homebirth-related) in indigent
maternity wards as well as upper class wings where privileged women had been convinced to try the
"modern" setting.
In the 1850s, Drs. Simpson (Scotland) and Seimmelweiss (Austria), in separate inquiries,determined
the iatrogenic (doctor-caused disease) roots of the rampant puerperal fever and immediately
instituted strict hand-washing in their regional hospitals, with immediate and drastic improvement of
mother & baby survival rates. In the decade following, hospitals in all the major cities in the Western
world followed suit in their maternity wards. They also decided to implement hospital-wide hygiene
standards, improving the survival of many other people - God bless Simpson and Seimmelwiess!
In contrast to the lack of wisdom in western urban health history, in the pre-colonized Native American
context as well as the Eastern world, traditional midwives and the medicines of traditional Africa, India,
and Asia often had unique and effective hygienic practices such as usage of antimicrobial herbs,
practitioner purification rituals, and/or non-invasive protocols. Likewise, in ancient Greece there was
extensive knowledge and practice of hand-washing and general hygiene - they even had a Goddess
named Hygieia.
Vocations and Careers:
The Spiritual Midwife, The State Midwife
The history of traditional midwifery in the western world is quite a fascinating one as documented by
the social historian Hilary Marland in the extensive scholarly text The Art of Midwifery: Early Modern
Midwives in Europe (Routledge,1993). Another well-researched text that contributes to this realm is
the must-read classic Nurses, Witches, and Midwives: A History of Women Healers by Barbara
Ehrenreich (Feminist Press, 1972).
Historically, whenever midwives have given themselves over to church or state law, there has been a
subsequent period of flourishing for a select group of a few 'registered' midwives who practice
according to the interests of the prevailing authorities, and a marginalizing of those who do not, many
of them traditional healers. The 'interests' of these authorities were costly tax & registration payments
(in the case of government mafias) or the carrying out of baptismal mandates or extracting of secret
details from unwed mothers for public shaming (in the case of early Vatican law). Modern interests in
today's context would be likewise costly licensing & taxes, as well as competition for healthy pregnant
clients between hospital and non-hospital based practitioners.
Each period of a flourishing midwifery elite in western culture has directly been followed by a period of
widespread social backlash and punitive legislation when the tides of prevailing authorities and social
liaisons would change - as they always do - ushering in imprisonments, and various restrictions
diminishing all midwifery (not unlike the current American context where several licensed and
unlicensed midwives in most states have been legally harassed and/or imprisoned and where CNMs
are finding it more difficult to sustain a home or hospital practice). It is estimated that during Middle
and Late Europe hundreds of thousands of people were considered 'infidels' by various dominating
groups at the time and killed during the Inquisition as well as various wars - many traditional healers,
herbalists, and midwives being among them.
Upon the settlement of North America by the English and Dutch in New England, the rising authorities
of Puritan governing bodies ushered in new backlashes against traditional women's wisdom culture,
with the infamous Salem witch hunts among them, wherein any free-thinking & free-speaking person
who did not conform to or who threatened the religious order at the time was freely imprisoned and
executed.
Midwives and Male Healers
Traditional birth attendants from ancient tribal societies as well as more modern European or
American rural peasant/sharecropper communities would, on occasion, confer and collaborate with
men who were tribal healers or country physicians, when faced with an ill mother or an unresolved
complication.
Traditional midwives were keen observers of physiological signs & symptoms and monitored fetal
health by addressing the mother's intuitive process, and, more recently, by using wooden acoustic
listening devices (called Pinard horns) still used by Amish midwives, and later, fetoscopes, as did all
early physicians. Traditional midwives relied on maternal signs & symptoms and dialogue much more
than internal exams (doing very few, if any, vaginal exams in labor) did not practice surgeries such as
episiotomies, nor did they do venipuncture administration of fluids and drugs. Such practices would
have been considered the domain of doctors rather than the art of midwifery.
My own grandmother told me of her midwife mother's friendly relationship with their rural family doctor
who referred healthy farm ladies to her saying "You don't need me, you need Minnie Mae." Likewise,
my great-grandmother and the doctor had an understanding that she could alert him for conference
and/or assistance if ever she needed, and at least one time she did, with a positive outcome for al.
This legacy of positive inter-relationship between faith-based midwives and free-thinking male
physician-healers of the time existed in the rural Black south as well. Traditional "grand midwives"
were openly supported by a scattering of empathic physicians who recognized and properly esteemed
the quality care of rural midwives in a time when the burgeoning American
Medical Association (99% male at the time) was generally demeaning and/or seeking punition towards
non-medical birth attendants.
The growth of immigrant cities as well as rural migration brought potential clients to growing urban
hospitals and created a social trend whereby the new medical establishment began to "manage" many
births, even for healthy women.
Modern Birth Attendant Options for Healthy Women
Obstetricians
Obstetricians are the most common choice of maternity care provider and birth attendant in the US,
especially in situations where a pregnancy is considered “high risk”.
Although many obstetricians are becoming more supportive of a less aggressive and less invasive
approach to childbirth, there still seems to be a prevalent belief that childbirth is a condition that
needs to be managed, rather than a physiological process that, in most cases, will and should be
allowed to occur, empathically facilitated with little to no intervention. Likewise, prevention of illness
during pregnancy through nutritional education is rare with obstetricians, as they typically receive only
4-6 hours of nutrition class times, as compared to the hundreds of hours of apprenticeship, study,
and practice of midwives.
Obstetricians can vary greatly in philosophy and internship experience, and the vast majority of
obstetricians have never witnessed a homebirth or a waterbirth, nor have they been educated in the
appropriate use of birthing pool for pain management. There are exceptions to this rule, such as the
famous women's health advocate Christiane Northrup M.D. and Christine Sebastyn M.D. of Austin,
Texas.
Many if not most obstetricians have never witnessed a first-time mother (primipara) give birth without
drugs in the labor room. As obstetricians are primarily relied upon by hospitals for logistical
supervision and actual delivery of babies, most have never provided continuous emotional labor
support and coping guidance for a laboring woman - and frankly, the vast majority of modern
obstetricians do not consider labor support a requisite skill for them to master.
Being that the Latin word root of "obstetrics" is "to stand in front of or to obstruct" and that old
English's "midwife" means "with woman" it is not surprising that obstetrics is focused on a mastery that
depends on interventions as its forte. Taking that into consideration, it is important to interview a
potential obstetrician with candor and depth, which necessitates informed choice preparation on the
part of the pregnant woman. Unfortunately, many healthy pregnant women find it difficult to even
make serious inquiry of a potential obstetrician, due to inhibitions and the overwhelming cultural
imprint of doctors-as-experts! Many women simply go with the friendliest OB of what's available with
their insurance, or the referred doctor-associate of a fertility tech MD, or the obstetrician that an
acquaintance simply has described as "really nice" - for the most intimate and personal journey of
their lives.
Many healthy, "low-risk" women feel that an obstetrician can provide a higher quality of care, because
of their medical background, training and a perceived ability to handle complications and emergency
situations more effectively than a midwife. This is not necessarily the case, especially when you
consider the fact that conventional medical school education perpetuates the misconception that birth
is an inherently dangerous event and our babies need to be “evacuated” from our wombs as quickly
as possible by using "interventions as preventions". Conventional medical schools and their
textbooks are still promoting the paradigm of women laboring in a bed, if not completely on our backs,
and being managed by IV administrations. This creates a tendency to "over manage" birth, and
significantly increases the risk of further and serious complications to the mother-baby, including but
not limited to an increased risk for cesarean section.
General or Family Practitioners are an alternative to obstetricians, especially in Britain and Australia,
famous among them being the Australian Sarah Buckley M.D., prolific author and home birth mother
of four. They are trained to provide well- and preventive care and more family-oriented, and often
view birth as the more natural, family-centered event that it is. Many women who chose a general or
family practitioner as their maternity care provider and birth attended can be very satisfied with their
birth experiences and the more personal care provided by their family physician. Of course, even
though they may provide well-woman care, many American GPs do not provide maternity care or
attend births because of malpractice insurance issues as well as difficulty securing hospital privileges
due to the highly competitive nature of obstetrical interests promoted by the American College of
Obstetricians and Gynecologists.
Friendly questions to ask a potential OB:
Have you done further studies in nutrition? What is your nutritional philosophy for prenatal care?
Are you interested in pre & perinatal psychology?
What are the benefits of drug-free birth, as you see it?
About how many primaparas have you seen give birth without drugs? Multiparas?
Have you ever provided continuous labor support for a parturient woman?
Do you feel that Doulas are an asset for public health?
What's your current episiotomy rate? Is this rate decreasing in your practice?
Would you feel comfortable caring for me if I was walking around in labor?
Are you willing to adapt to my chosen birth position during second stage? What if I don't want to be up on the bed?
Would you be able to commit to being informed about my birthing intentions to the best of your ability?
As a healthy woman, I am birthing at a hospital for "just in case" reasons, would you be supportive of this approach?
Part of that minimal intervention is that I don't want my vulva cut in the event of possible tearing, are you prepared to do
perineal support or hot compresses? If not, can my Doula assist with this?
I would like to implement current knowledge about the benefits of immediate skin-to-skin reunion with my baby, even
in situations of surgery. Would you be able to commit to facilitating that for us?
Midwives: Medical and Traditional
The Midwifery Model of Care is based on the fact that pregnancy and birth are normal life events and
that philosophy is usually reflected in their approach to childbirth. Midwives tend to be conscientious
in helping a woman co-create her own birthing experience. Midwives dedicate more time and
attention to individual cases, typically spending an additional half hour of each prenatal appointment
discussing personal or nutrition matters beyond vital signs and lab tests.
Medical Midwives
CNMs: Certified Nurse-Midwives (CNM) are chosen as the primary attendant for a significant
percentage of US births in both freestanding birth centers and hospitals, often times in conjunction
with obstetric practices. A small number of CNMs practice as independent homebirth midwives.
CNMs are regular RNs with an additional year of training in midwifery. Client education is a major
theme in their practices.
CNMs are often restricted to some degree by the current obstetric model of care, and indeed their
general practice is discouraged by a portion of AMA-associated legislative and political bodies,
varying state by state. A CNM is oftentimes limited to provide maternity care for women who have had
“low risk” pregnancies (an ambiguous term that seems to eliminate most everyone these days) and
any situation involving possible complications would be referred to an obstetrician. Most CNMs have
never attended a homebirth and some may not have much experience or commitment towards
facilitating instinctive birth.
LMs or CPMs: Direct-Entry Licensed Midwives or Certified Professional Midwives are under the
jurisdiction of the state, and supervised by state medical or nursing boards. LMs/CPMs attend a
much smaller percentage of births in the US, in freestanding birth centers and in homes. Training for
a direct entry midwife varies depending on state licensing requirements, but usually involves an
extensive apprenticeship with an experienced midwife involving a variety of homebirth and sometimes
birth center scenarios, along with completing an academic formal midwife-training program.
LMs/CPMs tend to focus more on whole-body wellness (specifically nutrition and its impact on healthy
pregnancy and birth) and women's education. They often create more personal relationships with
clients due to smaller practices, dedicating more time and attention to each individual case, and
aspiring to establish emotional and physiological support to their clients for the pregnancy, birth and
postpartum.
LMs/CPMs do at least one prenatal home visit, and several postpartum home checkups in the first
days and first two weeks after birth. This is very attractive to women who are choosing intentional
confinement at home the first 40 days, greatly reducing potential stress on the new mother-baby who
are generally expected by OBs and CNMs to leave home and travel for office visits during this
supremely tender time. (OBs and most CNMs do not have practices that are designed to incorporate
any home visits, and will refuse to come to the home for early postpartum follow-ups, if
requested).
LMs also provide consistency in care, usually being the only care provider that their clients see during
their prenatal visits and who will attend their births – not the unpredictable “OB or CNM roulette” that
is found in so many hospitals and birth centers. This consistency provides a level of security that can
create a more positive and relaxed pregnancy and birth experience for women and families.
LMs/CPMs seek to help women successfully birth outside of the hospital and have chosen the
responsibilities various EMT medical tools and interventions in the name of home birth. These
medical practices, many of which can be refused by clients, include regular ultrasonic doppler checks
(some carry portable EFMs, and some others are willing to use fetoscopes or pinards if requested)
and may include amniotomy, IV antibiotics, oxygen administration, cutting of the vulva (episiotomy) in
5% of clients, suctioning and wrapping of baby before giving it to the mother, typical severance of
the cord before the birth of the placenta and/or within 10 minutes of birth, injections of pitocin in forth
stage, injection of lidocaine for suturing, newborn weighing and Vitamin K administration within the first
hour of birth, and PKU heel stick newborn tests.
Many medical midwifery practices have a large client load, with midwives' energy being spread thin
when there are back-to-back births and postpartum visits to accomplish. The lighter your medical
midwife's monthly schedule is, the more available her energies will be for authentic relationship with
you.
Friendly Questions to ask a potential Medical Midwife:
What sorts of settings have you attended births in? What is your current client load?
What happens if you have more than one client in labor?
Are you open to taking a low-tech approach? (fetoscope, minimal VEs, minimal interruptions)
Do you provide traditional labor support services throughout labor if needed? What sorts of activities might that entail?
If not, do you welcome Doulas?
Would you be comfortable supporting me in a birthing tub?
Are you comfortable supporting my committed partner to support me in private?
In the unexpected scenario of hospital transport, would you continue with me in a labor support capacity?
Will you do at least one prenatal home visit appointment? Are you supportive of a 40 Day postpartum intentional
confinement for healthy mother and baby?
Are you informed about extended-delayed cord severance and non-severance, do you ever facilitate Lotus Births?
Traditional Non-medical Midwives
Though common throughout rural North America in the first half of the 20th Century, Traditional
Midwifery has declined in recent years, as elderly "grand-midwives" have passed away and
apprenticeship options in the old arts of midwifery have become quite limited. Along with this has
been an aggressive social promotion of obstetric dependency for healthy low-risk women by the
American Medical Association, state lawmakers, and the mainstream media, much of it based in
misinformation and/or profiteering.
Subsequently, the arts of non-medical midwifery are rare to find and less openly promoted, though
still existent in some communities of various orthodox religious or spiritual sects (Amish, Hasidic
Jewish, Mormons and rural Christian-Patriots, and Spiritual Ecologists to name a few). Because of
current state control of "midwifery," any midwife who is paid to attend a birth can be arrested and
significantly harassed by ignorant civil servants and medical/nursing boards for any negative outcome
or complication, regardless of client support and understanding. As traditional midwives do not use
medical tools and do not perform episiotomy, rather than being charged with "practicing medicine
without a license" they are instead faced with scapegoating accusations of "negligence" if an
unresolvable maternal complication arises for rural hospital transport or a baby arrives with birth
defects.
As Robbie Davis Floyd Ph.D. (Birth as an American Rite of Passage) and Suzanne Arms (Immaculate
Deception) and Ricki Lake (Born in America) have documented in their birth industry research: 1)
maternal complications in otherwise healthy women happen consistently in the hospital, 2) maternal
mortality rates are deceptively accounted for as "Anesthesiology
complications, and 3) American hospital-based birthing care results in being only 27th on the WHO's
list of nation-state Infant Mortality prevention.
From a feminist perspective, the diminishment of the art of traditional midwifery in name of medical
midwifery and obstetrics for healthy women may certainly not be in the best interests of all women and
babies! For anyone who esteems their civil liberties and the pursuit of life, liberty, and happiness in
their own bedroom/home, this can create a personal dilemma when desiring traditional, non-medical
care for religious or informed-choice reasons as it can be very hard to find such a practitioner in the
current professional environment. There are some traditional midwives, such as Jeannine Parvati,
who stopped attending births altogether, instead focusing their midwifery skills on helping healthy
women prenatally prepare to be their own midwife for a planned freebirth.
Planned Freebirth
Freebirth, or planned unattended birthing is another option for healthy women who long for an
instinctive home birth in the manner that they conceived their baby, choosing this path out of
abundant options rather than out of lack of choice, or isolation. This birthing option has recently
received more media coverage, as the numbers of educated western birthing women who choose this
path has increased (1%-9% of the home birth community, depending on region, Australia being the
highest). Freebirth is different than emergency unattended birth, which is usually precipitous (very
fast) labor of a third, forth, or fifth child, often occurring in car or taxi on the way to a hospital!
Historical unattended births include that of Christ, and Mahatma Gandhi caught his third child without
a care provider present (because, unexpectedly, the white South African local midwife simply refused
to attend his wife, due to race).
It can be very helpful for most healthy, inquisitive pregnant women to meet with other women who
have had freebirths and hear their stories, or at least see a freebirth documentary film such as A
Clear Road to Birth. Incorporating freebirth into the spectrum of possibilities definitely empowers the
general courage of many women who are planning various attended birth scenarios, as it makes
attended unmedicated birth seem even easier!
Healthy women who choose freebirth feel deeply assisted by their own intuition as an inner midwife,
and have worked on developing this through their life experiences, previous birth experiences, and/or
yoga & meditation sadhana (daily practice). They have also done extensive preparation and
research (even before conception), and many of them have attended births as a midwife, doula, or
friend. Healthy women who choose freebirth feel it is an inherently natural, mammalian, event of
privacy and sexuality, not requiring the presence of a professional attendant.
Many freebirth mothers are not primaparas (first-time birthing women), they have a 'proven pelvis' and
have given birth at least once before. However, an estimated 20% of freebirth women are indeed
primaparas, the vast majority of them highly educated and well-prepared (though certainly not all -
some unattended laboring women are in the category of mentally ill, addicts, or nomadic
homelessness, but this article is not addressing those ladies, who are technically not of the healthy
freebirth orientation).
It is extremely important, when considering an unattended birth, to become very familiar with the
physiology or childbirth, preferably through attending births or doing extensive study and training.
The proper orientation for a healthy woman and her partner enables you to recognize subtle signs
and symptoms of possible complications and respond to them with loving stability and flexibility. Most
freebirth families are well-informed of their options and strategies in the unlikely event of healthcare
back-up, and have a well-defined emergency plan should they need hospital transport. Birth in a
healthy, fearless woman is as safe as Life gets. Yet there are no guarantees, at home or in a
hospital.
Part of freebirth preparation includes dealing with the highly unlikely but nevertheless possible reality
of complication or loss, which all women face, but which is most negatively judged when it occurs
within a freebirth intention situation. Complications are normative in the hospital environment,
however, there is little compassion for complications that occur in the unattended home environment,
due to cultural and family psychology. For freebirth mothers, this involves taking 100% responsibility
and being prepared to deal with any backlash among peers and state law should there be any
complication that fails to resolve. Transport to hospital for freebirth mothers during labor is often met
with alarm and negativity on the part of hospital admissions or emergency room staff. Therefore,
some freebirth mothers choose to be covered by obstetric or CNM prenatal care for 'just in case'
personal backup, upon which their conservative hospital transport involves less stress (though often
their previous care provider will be unavailable or unwilling to attend anyway).
Prepared freebirth women commonly report an expanded capacity for birth pleasure and ecstatic
birth. And, like all women, these women also report having intensely uncomfortable or painful and
challenging moments in labor! However, there is a markedly reduced incidence of unresolved
complications compared to attended, healthy parturient women, which is a subject of fascinating
discussion in the freebirth community.
| 2500 B.C., India |
