MIDWIFERY’S RENAISSANCE
All doctors have been trained to look for trouble (diagnose a problem) and decide what to do about it (decide on a treatment), and that is what comes naturally to obstetricians. In prenatal care they take the same approach, focusing on what can go wrong. Another important difference between midwife-attended low-risk birth and obstetrician- attended low-risk birth is the quality of the experience for the woman. Many surveys have shown that women who have midwives as their attendants have far higher levels of satisfaction with their birth experience than women who have obstetricians attending their births. This is not hard to understand. Midwives give great attention to building close relationships with their clients and their clients’ families. Generally speaking, midwives are direct, open, and honest in their dealings with clients and take an egalitarian, intimate, woman-to-woman approach. Midwives do not guarantee a good outcome, and their honesty about their role and its limitations contributes to the level of satisfaction women feel with their services. On the other hand, in a doctor-patient relationship, there is no egalitarian tradition. Rather, the doctor’s superior knowledge and status are for the most part unquestioned and there is a belief (or hope) that the doctor can perform miracles. Midwives, like doctors, are human. They have bad days and they make mistakes. Science now tells us, however, that overall, midwives are safer than doctors for low-risk births. If a woman is among the 80 to 90 percent of all women who have normal pregnancies, the safest attendant for her hospital birth is not a doctor but a midwife. In the past two decades we’ve seen a renaissance of midwifery in the United States. Each year, the number or births attended by midwives increases. The more the practice of midwifery grows and succeeds, the more threatening midwives are to the obstetric monopoly, so, predictably, there has been an obstetric backlash. Now, a hundred years after Hanna Porn was persecuted, we have another American witch hunt against midwives. In many states, doctors are reporting midwives to various authorities as dangerous. In many cases, these attacks are simply attempts by doctors to eliminate the competition. Cases against midwives are, with very rare exceptions, not initiated by the families the midwives serve, as is typical of litigation against obstetricians. Instead, they are initiated by physicians. In the past several years in many states, including Illinois, Utah, California, Vermont, Virginia, Nevada, Oregon, Indiana, and Ohio, police have arrested direct-entry midwives for practicing nursing or medicine without a license. Maternity care in the United States is changing, and one of the most important changes still in progress involves who will catch the 3.5 million babies a year whose mothers have had normal pregnancies.
