Midwives: Reclaiming Maternal Health Rights

What’s the first thing that pops into your mind when you hear the word ‘midwife’? For me, it was outdated homebirths and ‘70s hippie women. With the medicalization of the birthing process in America starting as early as the late 18th century, obstetricians began to replace midwives in labor and delivery. The birthing process, a non-medical progression, became pathologized by biomedicine and depicted as a problem.

The idea of birth as perilous and baleful spreads in areas where biomedicine dominates. The result has been the normalization of and reliance on medical technology and the authority of the physician during the birthing process. Women have come to fear pregnancy and the birthing experience, as well as lose trust in their body’s intrinsic capabilities. My feminist nature pushed me toward midwifery and away from medicine. To me, the experience of giving birth is incredibly empowering and inspiring. Every pregnant woman deserves the right to information, resources, and support. As such, she has the agency and the autonomy to make informed decisions about her birthing process.

Midwives are healthcare professionals that provide prenatal, labor and birth, and postnatal care to low-risk women. They are dedicated to informing women of their options, involving them in decision-making, and providing them with holistic care. Women cared for by midwives, rather than obstetricians, are less likely to have invasive interventions or surgeries, such as a caesarean section or episiotomy (an incision of the perineum to enlarge the vaginal opening). Here, the midwifery model of care focuses exclusively on the natural aspects of birth and aims to lower rates of intervention.
In contrast to the midwifery model of care, the medical model relies on technology for labor and birth and has higher rates of intervention. The difference between the two models comes down to a contrast in ideals, norms, and practices. Due to conflicting ideals and practices, midwifery has been depicted in popular culture as insufficient and old-fashioned in comparison to obstetrics.

If midwifery is so “insufficient” or “old-fashioned,” why might a woman choose a midwife as her maternity caregiver rather than a medical doctor? I found the answer to this question in my interview with Lisa Hampton, my teaching assistant for an Anthropology and Women’s & Gender Studies class, “Gender and Culture.” Hampton is the mother of two girls, aged 4 and 9. Both of her girls were birthed in her home. She shared that she appreciates the fact that the midwifery practice is based on the philosophy that birth is a normal physiological process. She values the person-focused, individualized care that midwives are reputed for providing.

Hampton’s experience reflects what most recent evidence-based maternity care research shows: that the midwifery model of care has many favorable outcomes for mother and baby. For instance, women attended by nurse-midwives are less likely to experience the birth of a baby with low birth weight, the death of their baby in the first four weeks of life, and the death of their baby in the first years of life. Additionally, women who are cared for by midwives also have a lower chance of labor and birth interventions. So why does it matter? After all, there are some women who choose to have a caesarean section.

One reason is that C-sections are expensive. In America, it costs about $20,000 to have a C-section, while vaginal births cost $11,500—a C-section is nearly double the cost! Secondly, C-sections carry significant risk for most women. For example, low-risk women who have unnecessary caesareans are more at risk for experiencing hemorrhaging, blood clots, and bowel obstruction. These women are also at risk for future complications in pregnancy, such as uterine rupture and placenta issues. In their future pregnancies, their babies face risks such as respiratory distress, asthma, and obesity.

Lastly, C-sections and other unnecessary medical interventions rob women of their agency to give birth naturally. Women who have little knowledge or say on medical interventions lose trust in their bodies and their strength. I strongly believe that it is a woman’s right to know all of her options, so she can make informed decisions about her birth plan and give birth to her child according to that plan. I aspire to be a nurse midwife so that I can advocate for these specific rights of women. Whether it is solely caring for low-risk women or co-managing high-risk women with medical doctors, as a midwife I can help optimize the birth experience for mothers. With the renormalization of birth processes, women can reclaim and embrace the power that has been lost in the hype of biomedicine in the United States. Midwives serve as maternal health advocates who seek to reclaim the autonomy that women rightly deserve.