a midwife for every woman.

it's been one month since i've written. i should have been. it's been busy and exciting and satisfying. 

in my last post i wrote about the CPM symposium. 

well i'm going!

there was a scholarship offered. i applied. i was granted the award. so next month, i'm headed to D.C. 

this is such an interesting discussion that i have been having with midwives. i'm working with and have worked with midwives on either side of the divide. the divide being: should midwives be primary healthcare providers? or maybe the question is: are midwives primary healthcare providers? 

lay, traditional, modern, med. all terms applied to midwives. terms that seem to initiate hostility, drawing lines in the sand and determining the way they practice.

not really. all hold true to the tenants of the midwifery model of care. really! regardless if you agree with how each side practices, it seems each will argue the other is practicing irresponsibly. one says midwifery is lost, the other questions the quality of care provided. it's not as black and white as that. it's not that simple. and midwives do embrace each other. i'm not saying they don't. just trying defining the sides as simply as possible. like it or not. 

washington is such an interesting place to observe all of this. i love my midwives, all of them, all three of them. i love them for their diversity, for what they offer, for their views on things, for what i can learn from them.

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i am an eighties baby. i grew up in a very different world than midwives that began their practice before i was born. midwives that are self-taught, that were called to serve the women and families in their communities because there were no other options. out of need. whether spiritual or practical. 

understanding the context in which these midwives emerged, in which they practice is important. their skepticism of modern medical standards should not be dismissed. we need them to challenge what many so readily accept. a model in which us younger generations are a product of.

we live in a world of evidence-based practice, but so much of what midwives do will never be proven by science. there is no money it, there is no standardization. it's specific, intuitive, regional based, anecdotal. 

midwives trained in the old ways, so to speak, have knowledge of herbs, of homeopathics, the effects of nutrition. they use this knowledge in practice. they believe that observing a women is as important, if not more important as diagnosing a woman with a disorder through a medically-based test. 

this is not always copacetic to the thinking and practice of today. but that doesn't mean it should be thrown out. 

the question is, can you throw out an evidence-based, but not perfect test, for intuition? can we dismiss a standard-of-care that we have agreed to offer in order to practice legally, because we don't agree with it?  is that informed-choice? is it safe? what effect does it have on the judgement of the profession in a national/international context?

i'm not judging, i'm observing. understanding. questioning. trying to merge both sides. traditional midwifery does not need to be at odds with midwives embracing a role as healthcare providers. 

i strongly believe that there is a midwife for every woman. and that the decision to be a midwife is a political decision. it may not have been thirty years ago (or maybe it was even more so), but today, with midwifery emerging as a prominent profession that is becoming recognised as a safe, cost-effective and high-quality means of maternity care, practicing outside of this so called standard-of-care may put the entire profession at risk.

i haven't even touched on midwives as primary healthcare providers and how that fits into the picture.  i'm not sure if the issue is a moot point. what will happen to midwives that refuse to play nice with the "system"? 

this is all percolating in my brain.   

oh this brings up so many topics. the right to homebirth, the rights of birthing mothers, the rights of midwives, access to midwives.  

Midwives. More than Baby Catchers.

Below is the introduction to the paper that I am writing for school. 


Would love to hear ideas, opinions, thoughts on this topic. Are you interested? Do you find this relevant? Do you as midwives and student midwives place yourself or desire to place yourself within the context or role of public health provider? 

What role do midwives play in public health?

The role of midwives within overall healthcare is seen to vary across nations. In some countries, UK and Canada, midwives are integrated into the overall maternity care system. In the UK for instance, midwives are the state mandated care providers for all normal healthy low risk women, the place of birthplace is irrelevant to the choice of care provider. In the US, midwifery varies from being fully integrated (CNM’s and CPM’s in some states) to unregulated and in some states the practice of midwifery is illegal. 

Midwives, if placed within the context of public health are in a unique position to screen women for psycho-social, and disease and illness risk factors, in addition to providing prenatal care. Pregnancy is a period of a woman’s life in which she will seek out the routine care of a primary health provider. Midwives have the unique opportunity to help women at a most critical period in their life.

The following is a historical review of the evolution of women’s health framed in the context of public health promotion. Through this review we will see how public policy has become shaped by the understanding women’s health is shaped by the biological determinants of a women’s biological. Understanding the specific demands that are placed on a woman, both physical and socially will help improve the health of women and in return the overall health of a population. Health professionals and policy makers, must focus their efforts in culturally appropriate ways in order to significantly improve upon the integration of preventative care in health promotion.

Through investigating the role of midwives in public health, I aim to show that even in the US, midwives are actively filling an integral role in maternity care and to differing degrees, general well woman care. The aim is to legitimize the place of midwives within a healthcare system, both in the eyes of the midwives themselves, but as well by other healthcare professionals and the community at large.

I seek to frame the context of this discussion in the ambitions set forth in the Ottawa Charter presented at the First International Conference on Health Promotion (1986), which first defined public health and initiated a platform for countries to implement public health. In addition, there will be a brief discussion of the numerous reports and bills that have come out in recent years including the Millennium Development Goals, the Global Strategy for Women’s and Children’s Health, the State of the World’s Midwifery Report, the Affordable Care Act and more recently the agreements set forth in the Home Birth Consensus Summit that took place in Oct. 2011, It is my goal with this discussion to illustrate what is being done and has been achieved, while identifying areas of requiring further improvement.

connecting midwives

so running through facebook, it occurred to me that I know a lot of (mostly) women in the birth sector, most are midwives or doulas, the rest activists.

What came to me is that there is no real forum for all to unite.

MANA is arguably that medium, but its too political. It has an agenda. In the UK they have ARM - Associated of Radical Midwives. These midwives are not some patch wearing activists that are storming the streets demanding what they want. They are average midwives, trained with in the British midwifery system and have fallen to being on a spectrum between obstetric nurse to independent midwife. The name itself denotes political power, but really the organization is about change, and the acronym (truncated from AROM - or artificial rupture of membranes) was something all too familiar to them.

In Canada and the United States, I don't see much unity. We have the Big Push for Midwives Campaign, but that focuses on certified professional midwives and is consumer led. Then we have ACNM (American College of Nurse Midwives) who have gained control of the URL "midwife.org". MANA - Midwives Association of North America represents all, but I don't think anyone could deny the direct-entry focus of their cause, trying to make midwifery a legitimate profession.

What I see from these organisations is a struggle from within to give self worth. The focus is on the group itself, rather than on the care of pregnant mothers.

Perhaps I am coming late to the game and dishonouring all of the work that has been achieved to this point that I can even be sitting here, an apprentice, a student, judging the system within which we live.


Maybe it's my own dissatisfaction within my self for not doing more to promote midwifery, but not just midwifery, access to it, the organisation and distribution of services, insurance coverage, prevelance, supply/demand, the list goes on.


I'm about to start a project that will exam choice of birth place. My null hypothesis is a despotic one, that birth is a white middle class issue.

This is not to say that there are problems with maternity care across all socio-economic or ethnic groups, but that for what ever reason, it is white middle class women that are leading the movement away from hospital birth.

Questions that arise include:
1. access to information
2. access to services
3. financial limitations
4. insurance limitations
5. cultural tradition

These are but a few factors that may influence a woman's choice of birth place.

Over the next while I will conduct a review of the literature that has been published on the subject. My plan is to analyze MANAstat information to find trends in the utilization of midwives. I would like to incorporate a maternity care survey to help further glean insight into this question.

Today midwives are returning as holders of community knowledge. Protectors of all that is natural and healing on the earth. But is this really true of all midwives? Do lay midwives, CPM, LM CM CNM all have access to the same knowledge?
Do we all practice under the same system of beliefs?

Returning the point I raised at the onset of this, what are midwives doing to join forces to help extend access to their services to a broader population?

First we need to recognize that as midwives today, the large majority of us are white, and most likely fall into middle class. Once we accept this disparity on the behalf of the caregiver, we may begin to understand the disparity in care being provided and received by consumers.


This is just a intro to the topic. One I will continue to address in the coming months as this project unfolds.

Comments, suggestions, thoughts and beliefs are welcome.