Tuesday, December 22, 2020

Midwifery and Bullshit


These are not midwifery tools, but they could be. 

I have started offering prenatal support and consultation to women who are looking to give birth in an autonomous way. Several of these women are being followed, or have been followed, by registered midwives here in Canada. I've also spoken to a few practising midwives in this country, and I believe our midwifery establishment is in crisis.

We were an unusual country. Midwifery was illegal in all of our provinces and territories until the 1990's, when provinces started to recognize that it would be useful to register and educate midwives in the medical model. During the twenty years from the 1970's until midwifery was legitimized and regulated, midwives worked illegally to assist mothers at home, and there were a few midwives who were charged with practising medicine without a license. 

During the 1990's, midwifery became regulated and legitimized in several provinces. Midwifery education programs were developed and offered in universities across the country. These programs were very hard to get accepted into, and required a formal academic background over life experience. Most of the original lay midwives who had been practising illegally before legislation were "grandmothered" in to the Colleges of Midwives, but the applicants who were accepted into the programs were generally younger and obviously less experienced. 

Midwives were and are in great demand. The supply is very limited, partly because of the restrictions that competitive educational options and limited employment options mean for anyone who is drawn to the practice. Provincial governments in Canada have succeeded in effectively reducing the number of potential practising midwives, either with restrictive educational possibilities, or by limiting the ways that midwives can practice.

Because of the lack of registered midwives, and because the available midwives were practising in the medical model, several women over the years in various provinces in Canada chose to give birth either unassisted or with Traditional Birth Companions. As well, midwives trained in the US or elsewhere started offering their services as midwives and attended women at home. This was risky, because with the creation of a College of Midwives, anyone offering restricted practices under the provincial midwifery acts could be (and were!) prosecuted by the provincial College of Midwives. So far, this has happened in B.C., Saskatchewan, and Quebec. 

The pandemic of 2020 changed the face of birth. Women who were hiring doulas to accompany them to their hospital births found that the hospital authorities had full power to limit the number of people present, and doulas were left at home in front of their phones, providing encouragement, support and continuity of care from afar (Hats off, shout out, Kudos to all you doulas out there!!!). Home birth was restricted or banned in some areas, and midwives were given even more rules and regulations they had to practice under. 

Hospitals were seen, rightly so, as places for sick people (hmmmm, isn't that what they always were?). A few women, certainly a larger number than in 2019, decided that they would give birth on their own. Others decided that they would continue with midwifery care and fill in the gaps with the council and support of other practitioners.

Here is a little account of what is wrong with midwifery today, gleaned from conversations I have had with women seeking answers, and why I believe it has gone wrong:

  • Newborn mothers and babies do not need immediate testing. They need skin-to-skin togetherness, if the immediate indications of their health is good.
  • Newborns do not have to latch on the breast like a champion within the first half hour of life. Again, they need skin-to-skin togetherness. Mother will need to eat and drink. Attendants should stick around with gentle attention.
  • If you say that you will offer a woman attendance at her home, and you visit her home and bring equipment and preparations ... she is not going to hear your quid pro quos and fine fine print at the bottom of your conversations. She will be deeply disappointed when you tell her that (for whatever reason, that has to do with YOUR infrastructure and organization of lack thereof) she cannot after all birth in the comfort of her own home.
  • Women over 40 are not inherently dangerous. They can carry a baby to term and do not need extra testing or worrying conversations about how risky their pregnancy is. That's why she chose you, a midwife, so they wouldn't have to be bullied.
  • Midwives have to learn to keep their faces pleasant. So many women have let me know that they got really scared when they saw a young midwife look at their lady parts with horror/fear on their face. A vulva or a newborn's head can look wildly psychedelic, but usually is no reason for alarm.
  • The word "should" doesn't belong in your vocabulary if you are attending a birthing woman. 
Women now, a small percentage but nevertheless a percentage, are choosing to give birth at home autonomously instead of seeking the attendance of a midwife or a physician. This fact makes me sad. Why? Because I believe that every woman deserves a safe and sacred place in which to birth her child. Some women want to birth in the hospital. That birth should be as respected and loved as a birth that takes place at home surrounded by a circle of women. Some women want to birth at home, and these women deserve respectful, kind, reliable, and legal midwifery care. 

There is work to be done!!!

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