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O Midwife, Where Art Thou?: Experiencing the Plight of Midwifery Firsthand

Last October, I wrote a piece about the misconceptions surrounding the midwife brand, so to speak, in a culture where many have painted midwives either as a relic from a rural and unsophisticated past or else as a fringe hippy behavior.

Fast-forward to June 2011, and I find myself only three weeks away from daughter #2 (With the second baby, that might just equal "anytime.") and once again in the regular consultation of a midwifery practice. We did research once we learned we were expecting, and there was no midwife to be found here in Bowling Green, Ky. (Last time around, we were living in New York City.) The closest midwifery practices we could locate were up I-65 an hour-and-a-half to Louisville or down I-65 an hour or so to Nashville. So, Amanda and I make the trek now every week to Vanderbilt so that we can get the type of pre-natal consultation we prefer.

Since writing my first article here on Fast Company about the plight of the midwife brand, I've met a variety of smart women, all of whom are dedicated to "fighting the fight" to change perceptions about midwives in the U.S. There's The Foundation for the Advancement of Midwifery, for instance, a nonprofit dedicated to advancing education, research and public policy for increasing the availability of midwives in the U.S. And there's a particularly compelling project called Where's My Midwife?. The site tracks areas where midwives have been fired or driven out of practice to bring greater awareness to issues surrounding the marginalization of the profession.

Most eye-opening for me personally was hearing from some of the people who run The Frontier School of Midwifery and Family Nursing. It turns out that the particular irony of our plight in having the close care of a midwife here in Bowling Green, Kentucky, is that The Bluegrass State was actually the birthplace of the profession of midwifery in the U.S.. The Hyden, Ky.-based Frontier School is actually "the oldest and largest continually operating midwifery institution in the United States," according to Midwifery Today, launching in 1939.

In my previous piece, I wrote:

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.

It's particularly ironic that such an attitude has developed and a lack of access exists for us in the very state that actually first acknowledged this profession. The smart folks at the Frontier School are working to try and reverse that mindset, to help people understand why the availability of midwives only increases patient choice without encroaching on the expertise of obstetricians. However, they're working with meager budgets and, like many states, midwives in Kentucky are battling uphill in a regulatory environment that is less than fully hospitable to midwifery practices and a society that doesn't "get" what midwifery means outside of homebirth (if even that).

We were actually shocked that, only after months of talking to professionals in midwifery and researching the topic, did we discover options for midwifery for home birth in our area. In our case, we weren't interested in home birth, though, and the only option for having a midwife as my wife's primary care provider in a hospital is to drive to Vandy.

The midwifery profession has to come together to protect their brand from the misperceptions that surround it if they are going to be able to increase midwives' relevance and awareness and connect the many small, grassroots organizations doing work in this field. I'm excited by the possibility as to what happens when these various initiatives find ways to share resources and energy, even when their particular missions/focuses of advocacy are somewhat different. But it's no doubt an uphill battle.

In particular, midwives have to educate people that the overarching title actually houses a range of professions/types. For us, uninterested in home birth, the midwife was a crucial choice for my wife's care in labor because they are an advocate who sticks by a delivering mother's side from the moment she goes into labor until after the baby arrives. That level of attentiveness and a flexibility in adhering to my wife's desires as the patient, alongside the availability of obstetricians were any complications to arise, drove our choice to once again go to a midwifery much so that we were willing to drive an hour each way for every appointment.

We've been particularly proud these past few weeks that our midwives are a key part of a new TLC series, Baby's First Day, a series which demonstrates the role midwives play in the birthing experience of mothers in a hospital setting. But our second pregnancy experience only underscores for us the deep need for an ongoing education campaign as to how midwives are a crucial option to provide for women across the country and in a variety of settings.

Sam Ford is Director of Digital Strategy for Peppercom Strategic Communciations, a research affiliate with MIT's Convergence Culture Consortium, and an instructor with Western Kentucky University's Popular Culture Studies program. Ford was previously the MIT Consortium's project manager and part of the team who launched the project in 2005. He 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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  • Sam Ford

    That's absolutely true, Carl. I've learned quite a bit about how different other cultural practices are. And, as I mentioned, it wasn't so long ago that midwives were a prevalent figure in birthing here in Kentucky. Many of my aunts and uncles, etc., were born at home with a midwife rather than a doctor. So it's interesting to see how quickly things have changed in rural areas. These days, it's much easier to find a midwife in an urban area in the U.S...which seems so strange and backward in so many ways.

  • Linda Bennett

    read this bit about Frontier Nursing Service being the origin of
    midwifery in the USA twice this month. They are marvelous and without
    them CNMs probably would be much less in evidence today....BUT...there
    have always been midwives in the USA, some licensed, some not, assisting
    mothers with home births. ALWAYS!!!!!

    have had their babies where they lived since there have been mothers,
    and, if they were around other mothers, they have had help. A woman who
    was particularly good at meeting the needs of mothers as mothers
    identified it were the communities' midwives.

    to the continued support of Professional Midwifery in the UK and Europe
    the physicians in the USA have, since Colonial times, agreed and
    conspired among themselves to drive Midwifery out of the USA. Many, not
    all, are still trying to permanently criminalize home birth.

    states suspended the licensing of new midwives during this era but
    continued to have licensed midwives into the 1940s, 1950s, and 1960s.
    During this dark period of time few (maybe no) midwives were able to
    obtain a license to practice midwifery until the recent resurgence of
    midwifery and home birth beginning with the alternative culture of the
    late 1960s and 1970s. States that currently license the Professional Midwife have taken 30 to 40 years to do so.

    wasn't until the 1940s and World War II that most mothers left the
    comfort and safety of their homes to enter the depersonalized hospital
    to be delivered instead of giving birth. No one has ever been able to prove that Continuous Fetal Monitoring with its straps and machines that go beep is
    preferable to a mother freely mobile during labor (free-range?) and
    intermittent monitoring with a hand-held fetoscope and a little personal
    attention. No one has ever proven that hospital birth is safer for
    low-risk mothers either.

    Midwives have always served the needs of mothers and families. Each mother, and each family deserves a midwife's care.

    May you and your wife have the care you need and a wonder-ous birth experience.

  • Sam Ford

    Thanks a lot, Linda! And I agree with you about midwives existing for much longer than the Frontier School was around. I tried to word it that it is the oldest professional school for midwives in the U.S. As I understand it, it was the first formal professional school for midwives...But I certainly know the practice of midwifery stretches far beyond that. In fact, my great aunt was a midwife in the rural area my father was born in and assisted with many of the home births of that era. Here in Kentucky, at a time when people couldn't get to a hospital easily if they wanted to, these unlicensed midwives were major benefits for their community...but I think there's somewhat of a crisis of identity in these areas, so wanting to distance themselves from the negative connotations of being a rural area...that the histories of these women and what they gave to the community is being downplayed and ignored.

  • Carl

    If there is one thing I learnt in antenatal classes (in Britain) it is that the experience of childbirth varies significantly between countries. In The Netherlands the vast majority of babies are born at home under the supervision of a midwife. If you’re expecting twins or you’re high risk, you deliver in hospital, but the social norm is for midwifery led care. In Britain most women only see a doctor when labour has started, and only then as a supplement to the care of a midwife. However, in Singapore it is apparently frowned upon to have anything other than a c-section, obviously under supervision of a doctor and full medical team. If American midwives want to build their brand they should point to the practices of the many other countries around the world where midwives rule the pregnancy and childbirth experience.
    Good luck with number two.

  • WendyCPM

    There is a vast difference between midwifery in a culture that embraces it (such as the Netherlands, Britain, Canada and most other countries in the world) and the American culture where, as the author puts it, "midwives are painted either as a relic from a rural and unsophisticated past or else as a fringe hippy behavior."  There are still states in this country where midwifery in the home setting is a felony (please note that it's not illegal to have a home birth -- it's just illegal to have a trained midwife there to help you if something goes wrong).  An afternoon browse through the cable "health" channels will offer up hours of TV shows portraying birth as a ticking time bomb where the life of the mother and/or baby continually hangs in the balance, further solidifying the impression that home birth is a crazy choice.

    Hospital-based midwifery services are frequently on the chopping block when budget cuts come around because they don't make enough money for the hospital; the low-intervention approach that appeals to so many folks like Mr. Ford and his wife (and that results in healthier outcomes for mothers and babies) is not aligned with the profit-maximizing goals of the hospital.  Low-intervention = low income.

    This seems like more than just an issue of how midwives can build their brand, but a cultural revision of what normal birth actually looks like and a realignment of national healthcare incentives.  Can a consumer education campaign drive all of these elements?

  • Sam Ford

    Great points, Wendy. That's why I wanted to highlight Baby's First Day on TLC, which stars the midwifery practice we're going to see. It features moms delivering at Vanderbilt, both patients of doctors and midwives. And, to me, it shows the distinct differences between the two experiences, which I think is nice. Ultimately, this is about choices, and it helps to see and understand how and why the experiences differ in order to help moms-to-be make the choice that works best for them...