unlearning the midwife
spamelita on Apr 11 2005 at 6:03 pm | Filed under: midwife practice
in talking about whether or not to feel for a cord around the neck as the baby’s head is born (which I don’t do), Sara Wickham has this to say:
Yet, after thinking about all of this, I am left to ponder the question that bothers me the most. Whether or not we do things like this as a regular part of our personal practice, why do we feel we need research evidence to support the argument for not intervening? In a model of midwifery that assumes normality, I would assume that midwives would need to see evidence that something is useful before incorporating it into their practice, not the other way around. Have we become that uncomfortable with the physiology and normality of birth that we would rather intervene than not? Are we so fearful of litigation that we feel we need to “do” rather than “be with”? And are these practices really so ingrained in us that we feel compelled to continue them on a routine basis unless – or until - they can be proven unhelpful?
This is so true and should be taught in every midwifery school. Just because your preceptor did something doesn’t mean that it’s the RIGHT thing to do. I think we DO too much - and hardly any of it is evidence based (polyester or cotton hats on baby’s head right at birth, managment of third stage, perineal support, suctioning babies with or without meconium). We do it because we haven’t been told NOT to.
Well, I think it’s time that we midwives start from the beginning. Nature works. We should only DO something if it varies from normal or if we’re asked. Holding the space means just that - holding the space.
We all have so much to UNlearn. We’re taught to DO so much - to be acceptable to the medical model of (s)care. To be able to interface with them. It’s one thing to have knowledge and skills - it’s quite another to exhibit them at every turn.
I’m hoping for a revolution with this new generation of midwives. We have so much ability to shift birth back to the mothers! To the families! We can do this together! Rah! Rah! 
After I’m done with midwifery school I am moving to where-ever you are so that I might be able to pick up all this beautiful wisdom! Thank you so much for sharing it, I hope it ripples out!
I am wondering why all those things got started in the first place. Could they actually be useful in some way?
That makes me feels better about the cord, I have wondered why it is so important to check. I am not pregnant but when I daydream of my next birthing that’s one thing that always stops me and makes me wonder how important it is.
Also, the thought of not putting a hat on a baby seems pretty wild to me. Not in a bad way, just, “hmmm, I never thought of that…okay…cool.” Isn’t it important to keep their little heads warm though? Does snuggling with the parents keep the baby warm enough? It seems like it would.
Hmmmm, very interesting. Whenever my son learns something new he tells me that he can feel his brain growing. I think I can feel it too.
I love it Pam! Damn, you should be writing a column for Midwifery Today! (Not that you need MORE to do :p )
It’s a good question Misty asks… why did all of these practices get started in the first place? Michel Odent has observed that yes, they are useful in some way — but not the way we would want to think. Nearly all cultures ritually disturb birth and postpartum, and his theory is that this has something to do with the fact that this happens in partriarchal, aggressive societies, that it serves them by interfering with the hormonal process of bonding, thereby diminishing the capacity for love. (See “The Scientification of Love”.) That would explain a lot in both traditional and more obstetrically-based midwifery.
It is at first hard to believe that women would allow this to happen, that women’s sacred traditions could have been co-opted without us even realizing it. But look, we have another common ritual practice that is even more obviously harmful to the individual, and it is upheld by women and even done by women to other women: the altering of female genitals, including circumcision of the clitoris, known in the West as Female Genital Mutilation. If women can be convinced that such a violation to another person is a good thing to do (For Their Own Good!), how much easier for them to accept less obviously harmful practices as beneficial, such as separation of the newborn from mother, or denying the baby colostrum.
Those of us involved in natural birth advocacy have worked to spread the word about the risks of medical interventions. But we have been slow to take a critical look at non-medical practices, as if the absence of technology and male care providers are the only factors necessary for determining whether a birth practice is good.
Off the top of my head, I can think of several common practices in midwifery that are non-evidence-based: checking dilation as a matter of course; manipulating cervical lips as a matter of course; insisting on eye contact with the mother “to ground her”; perineal massage and tissue support; directing the mother in how and when to push; catching the baby and immediately putting it on the mother’s stomach; directing the mother as to how to interact with the baby, including breastfeeding; asking the mother to deliver the placenta at a certain time; dressing the baby; etc. If you think about it, there are so, so many seemingly innocent ways to interfere with proper hormonal release in the mother.