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 Midwifery means "with woman," a perfect image for the holistic, individualized, woman-centered care midwives provide to women and newborns during pregnancy, birth, and the postpartum period. Midwife maternal care is strongly rooted throughout history in the tradition of women attending and assisting other women during labour and birth. With the emergence of modern medicine, however, birth fell into the realm of the medical establishment, and in North America, the practice of midwifery was virtually eliminated early in the 20th century. Birth was viewed as pathological, and intervention became commonplace. During the 1960's and 1970's, however, with the rise of the women's movement and renewed interest by grassroots women's organizations in reclaiming and honouring birth, the midwifery movement rekindled, and it has been growing steadily ever since. Today, the profession of midwifery is widespread throughout North America, and midwives have become increasingly instrumental in redefining birth as a natural event in a woman's life. This reemergence of midwifery and redefinition of birth carry implications well beyond the actual experience of birth. The relationship that develops between a woman and her midwife can be transformative and far-reaching, influencing how a woman perceives herself as a woman and a mother. This relationship becomes increasingly significant as women grow more and more isolated from family support systems in modern society. We were never meant to birth and mother "alone," but that's what most women do. The traditional "village" of midwives, wise women, mothers, grandmothers, sisters, and aunties is often replaced by a short medical consultation with a virtual stranger in a clinic and a rushed entrance at the time of birth. New mothers may feel very isolated and lonely as a result. Midwives bring a partnership of caring to childbearing women and their families. By focusing on childbirth as a journey that is unique for every woman, pregnancy and birth are encouraged to unfold as part of the full spectrum of life's experience. Women emerge feeling empowered and resourceful. When mothers and their babies are biochemically prepared at birth to greet each other in a unique state of alertness and readiness for breastfeeding and behaviours that lead to secure attachment, babies are primed for positive health benefits. The health and development of the baby and the family as a whole can be significantly influenced by the strength and quality of this motherbaby relationship. Unnecessary practices that separate mother and baby during the early sensitive period following birth should be avoided. Choosing midwives to provide maternal care A couple in Vancouver, Alan and Amy McGuiness, recently gave birth to their first baby, a girl, at home with the help of their midwife. Both husband and wife are extremely pleased with their decision. The decision was easy for Amy. "My mother is a midwife, and so there was really no question. I wanted a home birth if possible and no unnecessary intervention. I know that as long as everything goes smoothly, very little needs to be done. And I trust my body to know what to do. The midwives support this belief." Besides having complete trust in his wife to know what she wanted to do with her own body, Alan is also impressed with their midwife's approach to maternal care. He recalls, "Our first visit with the midwives was very reassuring. In their office, there is a big basket filled with slippers. When you enter the clinic, you take off your shoes and slip on a pair of slippers, and then you sit and drink tea while waiting for your appointment in peacefulness. They were sensitive to our needs." So when it comes to the actual birth experience, did the midwives make a difference in the labour? "I was able to have a home birth, which allowed me to labour in a place where I felt safe and uninhibited," Amy explains. "The midwives were present when I needed them, and they stayed in the background when I wanted privacy or just wanted to be with my husband. They let me lead the way, and that reassured me that my body knew what to do. Essentially, they gave me the confidence in my own ability to birth normally, and that influenced my ability to labour normally. It was the perfect birth for me." "The experience of birth represents the beginning of our family. My daughter was born into our embrace at home. If we had not had such a great experience together, our beginnings might not have been so perfect," concludes Alan. Rachel and Barry Teplicky in Toronto want to be well informed. Communication of the knowledge about the pregnancy, the delivery, the newborn, and any potential complications is the one most important thing that they are looking for. "Considerations in choosing a maternal care provider are, therefore, accessibility and availability of the provider and the provider's communication style," Rachel says. "We need to be able to ask questions between appointments and not only at appointments. The provider's interest and willingness to address and follow up with our concerns are important. We felt that the midwife practice can better meet our needs." When the couple considered pregnancy, they did their research. "We looked at different options. I searched the College of Midwifery website and located the midwives in my area." Rachel says, "Because they provide each woman a lot of maternal care time, they can only take a limited case load. Many of them are fully booked. I was fortunate to be able to connect with one almost right away." But the couple is pleased with the support they have received, especially in terms of prenatal education. "Our midwife dedicated a great deal of time to me and my husband, giving us advice around nutrition, exercise, and healthy lifestyle, and also prenatal testing, which is optional." Rachel gave birth at the hospital. "I want to have the best of both worlds," she says, "In case anything happens in the course of a pregnancy, the case will be transferred to a medical doctor or an obstetrician because of legal restrictions on the practice of midwifery. This transfer can create a bit of anxiety as the medical professional may not have the same birth philosophy as mine. But in a hospital setting, the best resources, when and as needed, are readily available. And my midwife will be there with me for the process. This combination gives me peace of mind." The couple also finds that not having to decide when to go to the hospital themselves gives them peace of mind. "When the contractions start, midwifes could come to the house. They decide when to go to hospital. We don't need to worry." Another key part of midwife practice is postnatal care. "After delivery, I'm coming home to establish breastfeeding with the help and advice of my midwife," Rachel says. Midwifery in Canada Even though about 80% of babies are delivered by midwives around the world, there is currently no internationally recognized credential for midwives, and their scope of practice varies from country to country. In Canada, midwifery care is not yet legalized in all provinces and territories. At the present time, midwives are registered and licensed to practice legally in Manitoba, British Columbia, Alberta, Ontario, Quebec, Saskatchewan, and Nunavut and have to pass standard of practice examinations. In terms of training, midwives in Canada have a number of options, ranging from self-study to university degree programs. Midwifery degree programs are offered in Ontario at McMaster University, Ryerson University, and Laurentian University, at Université du Québèc à Trois Rivières in Quebec, and at the University of British Columbia. Doulas are labour coaches, not midwives. They can work by themselves or with midwives. They can also be present at the time of labour and delivery and play a crucial role in providing emotional and physical support. |
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