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Cultural Misconceptions and the "Midwife" Brand

Communicators have long known that one of the most crucial ways to activate an idea in people's imaginations is to find a relevant way to discuss it and present it to them. I remember a colleague telling me that the makers of TiVo had him when they said, "Pause live television." That single concept made real what DVR technology had to offer him. As another colleague once said to me, much of what marketers do is create powerful metaphors that make a product, service, or brand immediately intelligible, to get at its heart and communicate its meaning efficiently.

It's especially frustrating when you see a brand or movement that should have that sort of immediate connection with people, yet something is lost in translation. And, today, I think there's a major disconnect from a branding and marketing perspective with what I would consider a key professional role in the world: the midwife.

The Business of Being BornIt wasn't that long ago that it was quite normal for children to be born at home, out of necessity more than anything else. Even a generation ago, one of my parents was born at home, and such occurrences weren't considered an oddity. Today, though, I'm amazed that "home birth" is considered some sort of activity for alternative lifestyles. What's more, midwives have seemingly been pushed to the fringes of our society more often than not.

The Business of Being Born points out the ways in which midwifery was demonized and questioned alongside the dawn of the modern delivery process, shown to be the purview of quacks and witch doctors rather than legitimate experts who know how to assist a mother through labor in a natural setting with few complications. The Business of Being Born is a polarizing film, I realize, but its points about the un-naturalization of the mid-wife profession that has happened in our country was hard to dispute.

Today, that concept of the mid-wife as being somehow unnatural or foreign has seeped so deeply into our way of thinking, it's amazing. When my wife and I were choosing a professional to consult with for our pregnancy, we were looking for someone whose offices were close to ours in New York City. We actually chose a mid-wife from our insurance list by accident. However, once we started going to her, we decided that we particularly liked the idea.

However, many friends and family demonstrated great concern. They were somewhat assuaged that we planned to deliver in a hospital and that our mid-wife consulted with a doctor in situations of any complication, but there was this feeling nevertheless that the only way my daughter would appear in the world would be through some sort of medical intervention—as if children weren't born before medical licensing boards came along.

Of the most surprise to me was that some family members in Kentucky seemed shocked and even concerned. As I said, it wasn't that long ago in these more rural areas where home births and experts who could assist in the community were the norm rather than the exception. Perhaps one reason the idea of a mid-wife seemed incomprehensible to some of our family and friends here in The Bluegrass State was because we really aren't that far removed from a time when travel was a concern, when people couldn't as easily make it to hospitals, and when mortality rates were higher because of those inefficiencies.

But, whatever the reason, the un-naturalness of the mid-wife seems to have formally taken hold. As I was thinking about the topic, I saw that there is no mid-wife available here in Bowling Green, where I live. The closest professional here in Kentucky would be a drive to Louisville. Meanwhile, many who prefer a mid-wife drive to Nashville instead.

The irony that only urban hubs now host mid-wives is massive. It's like only being able to get good barbecue or diner food in a city while small towns are now full of fast food chains, ironic of course because the city restaurants are based on what the small towns used to have. For midwifery, this has causes outside of the branding of the profession. For instance, medical malpractice insurance makes it very hard for a mid-wife to function in a rural area without a steady stream of expectant mothers to work with. But it seems that the largest issue of all has been a lack of demand and a belief now that the natural way to deliver a child is in the hands of a licensed physician.

The biggest hurdle to overcome is that many have painted midwifery in extremes: as only for parents who completely oppose medical intervention, almost as eschewing all that modern medicine and technology has given us. Yet, in our experience with Emma, my wife chose to take medication to help induce labor after being a week past her expected due date based on the counsel of our midwife and eventually also chose to have an epidural. But the midwife knew that our goal was to have a vaginal delivery and, despite constantly warning us that it might not happen and encouraging us not to rule out surgical intervention if there was no other way, she assisted alongside us for 18 hours. Once she arrived, she never left our side. She took naps by the nurse's station and didn't hover, but she had no other place to be. And knowing that made every step a little less nerve-wracking.

Many are battling these extreme notions of what a midwife is or does. Advocacy groups for midwives are quite active, and the rise of young mother movements amidst the growing influence of mommy blogger communities have given voice to pushing back against a culture of Cesarean sections, of excessive use of medical intervention, etc. But, to me, the battle will not be won until midwives can be positioned not as some new fringe "hippie-mother" movement but as a longstanding and natural part of the human experience, as part of rather than threat to the modern health care industry.

Sam Ford is Director of Digital Strategy for Peppercom, a PR agency, and a research affiliate with MIT's Convergence Culture Consortium. Ford was previously the Consortium's project manager and part of the team who launched the project in 2005. He has also worked as a professional journalist, winning a Kentucky Press Association award for his work. He also blogs for Peppercom's PepperDigital. Ford is co-editor of The Survival of Soap Opera with Abigail De Kosnik and C. Lee Harrington and co-author of the forthcoming book, Spreadable Media with Henry Jenkins and Joshua Green. Follow him on Twitter @Sam_Ford.

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  • Bonnie B Matheson

    Good article! Yes, there are many misconceptions about midwives. (no pun intended)

     But the biggest difference is the model of care. The Medical Model of Care treats birth as a disaster waiting to happen and a medical event. Midwives Model of Care essentially treats birth as a normal bodily function, not a medical emergency. 
    And then there are "Medwives" who try to be on equal footing with doctors and therefore completely cave to many of the "Standards of Care" considered "normal" by said doctors. And yet privately the majority of doctors actually dislike the "competition" from these women and do not really want any colaborators.Trusting Birth is at the core of good midwifery. Women must "own" their births and stop looking to either midwives or doctors to do it "for them". Birth is normal. Most women can have their babies by themselves if they have to.The perception that birth is a dangerous passage for women and babies is partly a PR campaign foisted on the public by OBs and others in practice of treating ill women.Pregnant women are not "ill". They are pregnant. Pregnancy is normal and does not require intervention in most women. Unfortunately the majority of women are scared of birth. No wonder. If they watch the dreadful and frightening TV shows depicting modern hospital births, they have plenty of visuals with which to frighten themselves. The PR that should be focused on, is the role of midwives as facilitators for women who are having their births naturally. Home birth grew by 20% between 2004 and 2008 in this country. And the RIcki Lake movie "The Business of Being Born" did not come out until 2008. It is my hope that the percentage of women choosing home birth will have grown even more since then. But I don't believe those statistics are available yet.The C-section rate in this country is abominable. Frightening numbers of babies are cut from their mothers bellies for all sorts of reasons that are just plain wrong. No wonder women are beginning to fight back by finding another way. 

    When a woman hires a midwife she can expect to become friendly with her. She will have long prenatal appointments and a lot of time talking about feelings and fears and preconceived notions of birth that may be harmful. She will have the undivided attention of her midwife during the birth. There is NO comparison between the two models of care. When the hours of one on one face time is compared between doctors and midwives, doctors lose.

    OBs have their place. High risk women should choose them, generally speaking. And OBs have indeed saved women and babies who would otherwise have died due to complications of illness or extreme prematurity.  But OBs often cause a lot problems for low risk women. They are so accustomed to interventions that they do not even realize what they are doing that is harmful. The C-section rate in the USA is officially 33% yet at some big city hospitals it is 60-70%. This is outrageous. C-sections are NOT totally safe. They are a lot more risky for mothers and babies than vaginal birth. Yet many women perceive them as "normal".

    Do your own research. The information is out there. Visit and read the recent articles about both midwives and doctors. Birth is an individual process. It is not "one size fits all". And it is too important to be ignored. Don't give up your "power" by letting someone who just sees you as a patient tell you that their way is best. Trust Birth.

  • Jill K

    1,007 words and the average reader still has no idea what a midwife actually does, other than sit with a woman in labor and nap at the nurse's station if need be. Might I suggest that your next article, rather than bemoan the demonization of midwives, or lack of access to them, focus on the skills a midwife possesses, the different types of midwives there are (lay midwives are illegal in almost every state, for instance, and women should run screaming from them), the rigorous training and licensing a Certified Nurse Midwife has, and exactly what role they play in the birthing process. Information like that would go a long way towards eliminating the two primary concerns your two recent articles have focused on.

    Congratulations and Best Wishes on your new arrival!

  • Sam Ford

    Thanks, Jill! And thanks for weighing in. Sorry for being so dreadfully long to respond. The Fast Company site doesn't alert me when new comments are posted to my articles, unfortunately. I think the information that you suggest would make for a great article, Jill...but it's not one I'm qualified to write. I'm a newborn father who, along with his wife, decided to see a midwife for the birth of both our children. I'm no expert on midwifery, or midwifery school, etc. I work in the marketing field, and I realized that the problem midwives face is one of not being properly understood/promoted. My purpose here is to increase awareness that there is a misconception; I'm not the expert that can properly explain midwifery. It sounds, though, like you have a lot of great information and insight...I'd love to see you share it!

  • Suzanne Wertman

    Thank you for this! You are absolutely right--we need a better brand. I am so glad you had a great experience with your midwife. I do wish that everyone knew that we're the ones who will listen to you, take really good care of you and follow the latest and greatest in research. We're the experts of "normal" and we would like to help improve outcomes like lower c-section rates and lower maternal and infant mortality rates. Instead, we're busy fighting for our jobs and for less restrictive practice acts because the established providers perceive us as a threat, rather than their partners in better care for women and families.

  • Sam Ford

    Suzanne, I think the key is a balanced view of what physicians provide and what midwives provide. It's not a war in which only one profession can exist, but unfortunately it's become so politicized so that, to your point, the time is spent on the argument and can't be spent on where it should be: giving expectant mothers the best advice possible.

  • Suzanne Wertman

    Sam, you're absolutely right. I am part of a group called "Where's My Midwife?" and we're working on this and I am wondering if you can help. I'd like to talk more with you, if you're willing, about our efforts to help women and their families get the best advice about their health care.