What is important is that it is her transformation. You cannot force a woman to be transformed in this way any more than you can force a caterpillar to become a butterfly. The most that can be done to promote the best outcome is to understand what is vital to the transformation and to meet those needs. For a caterpillar, this means ample nourishment, access to the right environment, and protection from predators. For a woman, it is the same.
When the needs are met, a woman has the best chance of having a healthy outcome for herself and her child. A mother who is transformed emerges from her birth with a growing confidence in her ability to face the future challenges that will come on her mothering journey. Those who witness this transformation develop a newfound respect and awe of the mother. Witnessing her transformation helps them to embark on their own transformation into parenthood.
The word midwife is literally translated “with woman.” No conditions should be placed upon this definition. A midwife recognizes the range of normalcy in birth. She is intimately familiar with the appearance of transformation; she either observes its unfolding, or is acutely aware of the lack thereof. Too often discussions surrounding issues of scope of midwifery practice focus on artificially constraining which women “qualify” to receive midwifery care, and which women are "risked out" of midwifery care. This is fundamental error. All women need and deserve access to midwife-led care! In fact, the women who are at “higher risk” need midwifery care even more than women who are “low risk.” They might also require obstetric care, and this should never be an “either/or” scenario, but a “both/and” situation instead. Yes, there are times when obstetric care is absolutely essential to promote the best physical outcome for mother and baby. What our culture has yet to rediscover is that midwifery care is absolutely essential for the optimal mental health and transformation of a woman into a mother.
The relationship of trust that is formed between a woman and her midwife is a key element of midwifery care. Within the context of this relationship, the midwife is able to assess the woman’s current state (nutritionally, emotionally, relationally) and provide individualized education and resources to help position the woman for her best possible outcome. One fruit of this relationship is the trust that a woman forms with her midwife. It is this trust that allows the midwife to gently lead a woman into making good choices for herself and her baby. This is important because learning to make good choices is essential to the mother’s transformational work. It cannot happen if a caregiver only offers one option, or coerces the woman to choose what the caregiver prefers, or threatens that the woman’s insurance will not pay for her healthcare if she goes against medical advice, or if a caregiver obtains a judicial mandate to force a woman to submit to a particular procedure. When the mother chooses, she accepts the responsibility of her choice. When the caregiver or the government limits or forces her decision, is it any wonder that it becomes very difficult for a woman to accept responsibility for her outcome?
When a proper relationship of trust is established, a midwife can tell a woman when she needs referral or transfer for obstetric care. The midwife can help the woman to see the need and to make a good decision. She can go with the woman to provide continuity of care and continue to meet the woman’s emotional needs. A highly interventive obstetric birth can still be—and for sake of mother and baby, it should be—a transformational birth. Being a midwife is not about fighting over who gets to catch the baby or who gets more money from an insurance company. It is about transforming a woman into a mother while seeking the best outcomes possible.
The hundred-year experiment of stripping women away from their community midwives has resulted in generations of untransformed women, walking wounded with physical or mental scars, who sometimes struggle to confidently chart their course through motherhood. For humankind to not merely survive, but to thrive, this must end. Scope of practice details belong to birthing women and the midwives who serve them. It is appropriate to uphold evidence-based practice, where the integration of the best research evidence, clinical expertise, and the mother’s needs inform her. Women deserve access to midwives who are trusted to utilize their education, experience and intuition to guide the woman to the appropriate care for her individual situation.
The work here, in our state, has barely begun. What remains to be done is much more than any one person can do. What I personally will be able to contribute will be a drop in the bucket compared to the need. The transformation of our birthing culture will be slow, much slower than desired. The demand for midwifery services will outpace the number of families who can be served. I know that there is a great sense of urgency for those who are expecting new babies, and I am saddened that the passage of a law cannot quickly translate into a midwife for every mother.
Today on the International Day of the Midwife, I honor those who have gone before me, those who have educated me, those who were “with woman” as I gave birth to my children, and those who feel the call to serve their sisters in the oldest profession since creation.