Editorial: Hands-On Care
by Jan Tritten

[Editor's note: This editorial first appeared in Midwifery Today Issue 70, Summer 2004.]

Mabel Dzata and Vi Sadhana

[Photo by Patti Ramos]

Mabel Dzata and Vi Sadhana at the Eugene 2001 Midwifery Today Conference

Look at your hands. These hands are holy-ordained by God to receive babies. What is the substance of this divine trust? What is the responsibility? Midwife, partera is a high calling. (All practitioners are midwives if "with woman." I am talking about the calling, not the profession.) How do you carry out your role? First, do no harm. If possible, do some good.

Relationship is the essence of hands-on midwifery care. How would you know without relationship that a birthing mother does not want her mother-in-law in the birth room or the myriad of other details she shares with you? Hands-on prenatal care ensures that by the time birth arrives, you are prepared to do this dance with her. Some studies have indicated that we do not need as many prenatal visits to get the same outcome. This might be so with drugged labors and cesareans, but we hold a higher standard. We strive for optimum outcomes, in terms of both overall health and maternal satisfaction. We want the mother to fall in love with her birth. Loving her birth will give her more understanding and patience with her baby.

Cornelia Enning

[Photo by Jennifer Rosenberg]

Cornelia Enning speaking at the Eugene 2003 Midwifery Today Conference

In practice, hands-on care takes many forms. Cornelia Enning offers what she calls "mother-led care." That is, she asks the mother to tell her how much guidance she wants from the midwife. Does she want to receive her own baby? Does she want coaching?

Some midwives use varieties of massage. (See the great article in this issue on massage.) Our Mexican midwife sisters have taught us many massage techniques. Their hands, hearts and very beings exude kind and caring "hands-on midwifery."

Ideally, hands-on care involves continuity, as it is difficult to truly protect families without this element. With hands-on care you teach and counsel during pregnancy how to prepare for a healthy birth. A woman doesn't intuitively know that good nutrition protects her and her baby from many complications. Midwifery must teach these things. Often you have to impart your trust in birth to women made afraid by their culture. We need to teach them their bodies are wonderfully made for this holy task.

For this reason, the most important elements we need to impart to motherbaby and family during prenatal care are faith and trust. To do this, we must have it ourselves. How can we impart trust if we do not have it? Where do we get it? We must guard our hearts and minds. If, as a student midwife or doula, you find that your education program is instilling fear rather than faith in you, consider changing programs. Our culture and society are counting on us to impart the sense of the miraculous, the trust and faith we find in birth, to the mothers we serve.

One midwife who faithfully carries out this holy calling is Mabel Dzata. She is originally from Ghana, Africa, but has blessed our community in Oregon for 25 years. When she came here she had already attended over 2,000 births. She immediately became, and still is, one of our treasured mentors. She teaches at many of our conferences and will be with us in Germany this October. She maintained a homebirth practice for years. Then she went through nursing school and then midwifery school and became a CNM. Mabel imparts to birthing women her faith both in them and in birth. As a nurse, she earned a reputation for getting the babies to be born just by being in the room with the laboring woman, often for less than an hour. How did she do this? She says, "Respect." Respect for the birthing woman and the sacredness of birth.

If we have the time in prenatal care, we can impart so much. This time we get with the woman is key to the birth experience. I tell you of Mabel because many of you do not have the luxury of time spent together, the essence of hands-on care. Our birth system is extremely dysfunctional. We must often work in the medical system while trying to change it. You midwives who work in it are much needed; your hands are just as ordained. The pressures on you are great. Often you do not have the chance through authentic, hands-on midwifery care during pregnancy to prepare for birth. You establish a relationship right in labor, but your respect for laboring women can heal a great deal. You still have much at your disposal with which to help them. You know what laboring women need—a quiet, dark, undisturbed place. You can establish a fantastic, protective relationship.

We must slice through the weirdness of our birthing culture and its myths and build our faith and trust. However, we cannot give from an empty well. We must fill up the well, because give we must. Few are we who understand this elemental process of bringing forth babies in love and peace, honoring the sacredness of birth. This knowledge gives us the responsibility to pass it on whenever and wherever we can. Please do it, because the world needs you more than ever.

Toward Better Birth,
 jan

Jan Tritten

Jan Tritten is the founder and editor-in-chief of Midwifery Today magazine and a midwife who was in active practice from 1977–1989. She became a midwife in 1977 after the powerful homebirth of one of her daughters. Her mission is to make loving midwifery care the norm for birthing women and their babies throughout the world. Meet Jan at our conferences around the world! [ PHOTO BY ANDREA NOLL ]

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