Subject: Midwifery:Introduction
Supersedes: <smm$9602.faq.intro@cony.gsf.de>
Date: 27 Mar 1996 09:48:30 +0100
Summary: This posting is an introductory posting about
.midwifery worldwide for sci.med.midwifery.  Additional
.postings will describe midwifery in specific   
.geographical areas.
Message_ID: <smm$9603.faq.intro@cony.gsf.de>

Posting-Frequency: monthly
Version: 0.01
Last Modified: 1995/10/6

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 back-up
with medical or shared care show that midwifery care was
associated with a reduction in a range of adverse psycho-
social 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 (in development)
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 
<cnmpat@aol.com> with the supportive assistance and
contributions of the following individuals.  Suggestions for
topics to add to the FAQ are always welcome.

Ms.  Sabrina Cuddy <swnymph@abekas.com>: 
Childbirth Educator, Nursing Mother's Council volunteer, USA

Ms. Elizabeth Couch <kindredspirit@shop.medchem.purdue.edu>
DEM, USA.

Ms.  Marjorie A. Dacko <WVUY22@prodigy.com>:
DEM, birthcenter practice, USA

Ms. Sharon K. Evans <BirthRite@aol.com>: writer and and
licensed DEM, birth center practice.  Co-chair for the NARM
Qualified Evalator Committee

Ms.  Cheri Van Hoover <CheriVH@aol.com> 
CNM, hospital practice, USA.

Mr.  Patrick Hublou <phublou@innet.be>: Midwife, Flanders,
Belgium

Ms.  Deirdre E.E.A. Joukes <065620@pc-lab.fbk.eur.nl>
Consumers-viewpoint, The Netherlands

Ms.  Debbie Pulley <ManaMW@aol.com> MANA  Legislative Chair
CPM, homebirth practice, USA

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