Editorial: A Knowledge Base Fit for All Midwives
by Jan Tritten

[Editor's note: This editorial first appeared in Midwifery Today Issue 69, Spring 2004.]

The question we must ask ourselves is this: Can a midwife survive a medicalized education and still come out an authentic midwife? One who knows the difference between lifesaving, necessary procedures and rituals, many of which are dangerous to the motherbaby? In a time of increasing cesarean sections and intervention rates as high as 99 percent in some hospitals, this is a question we must ask ourselves for the sake of society.

If we look at what is happening in hospital birth, the evidence shows that nearly all women should have a midwife with continuity of care and have their babies at home if circumstances stay within a normal range. We might need 100,000–200,000 new midwives.

Medicalization is very seductive and clandestinely so. I know midwives who began as lay midwives, got their CNM training and slowly became indoctrinated into the medicalization of their practices. They are like the proverbial frog in a pot of warm water on the stove; the heat is slowly turned up and the frog stays put, not realizing until too late that it is being boiled. I also know many nurse-midwives who have survived the indoctrination and can tell the truth from the myths, but it is a daily battle.

More evidence to support midwifery knowledge exists than ever before and yet we, all types of midwives, keep adding more and more unnecessary practices and protocols to our work. We can look to Michel Odent's work and ask the question he asks: "What do women in labor really need?" We know his answer. In brief, women need to be undisturbed to allow their hormones to function fully for the birth process; they need to be undisturbed by our routines so they can bond with their babies.

Michel explains that oxytocin is highest just after birth, if the mother has not received drugs, all of which block her own oxytocin. The woman's oxytocin is the mothering hormone. The new mother is flooded with it for the first hour after birth for the purpose of meeting and bonding with her baby. Disturbing the mother in labor and just after birth also disturbs her oxytocin level. Yet here we are talking, asking questions, giving shots and looking at machines. The mystery is that anyone can give birth and bond in this situation. The reality is that many do not.

So, what do we need to know to be good, protective, life-saving authentic midwives? Traditional midwives serving traditional societies do not have the same knowledge base that we do. Many have great statistics especially when dealing with healthy, well-fed women. What is their knowledge base? Of course, it varies from culture to culture and person to person. What can we learn from them and visa versa? Many years ago I worked on the NARM test with 15 other midwives. We were taking the test to see how biased it was. I turned to Sandra, a midwife who works regularly in Senegal, and said, "Well, at least it is a culturally sensitive test." She said, "No it isn't." That's when I realized that the test nails down the westernized cultural view of what one needs to know to be a midwife.

Robbie Davis-Floyd told me about a fascinating incident she experienced in looking over the NARM test given to very experienced traditional midwives, all of whom failed. She asked one traditional midwife about her experience taking the test. The midwife said when they asked about hemorrhage, "I thought of every hemorrhage I had ever experienced to answer the question." Needless to say the midwife got through very little of the test. She needed to go over every birth to decide why the hemorrhage was happening as well as the cure. She would apply different techniques to control the hemorrhage depending on the cause.

All of this makes me wonder if we can come up with a base of knowledge that we really need to have for the sake of women and babies, not necessarily to fit into hospital or medical routines or even to combat them, but to really serve women.

basic midwifery knowledge systems

I created this graphic to show how our basic midwifery knowledge systems differ.

These are difficult questions and concepts, but putting together a midwifery body of knowledge gives us something of a road map to the future of midwifery. We need to quit being Florence Nightingale, serving doctors and medicine. We need to realize that we are serving women, their babies and families, our society and God. If it looks no different than the myth-based, damaging knowledge and practice of obstetrics, then it is not midwifery. We need to begin pointing out that the emperor is naked.

As midwives and student midwives, we must reclaim our right to an authentic, accurate and changing body of midwifery knowledge. Changing because we are learning new insights all the time. Midwifery is a different profession than obstetrics; one dedicated to authenticity, with what should be all medical professions' foundation—to "first do no harm."

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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