Paper Written for Holistic Health, (Taught by Corinne Martin)

I interviewed Heidi Fillmore, a Certified Professional Midwife, for this short paper on midwifery. The class I am taking is called Holistic Health, and is a nursing class which explores how to integrate “alternative” medicine with allopathic medicine. I honestly wish the assignment was for a lengthier paper, I could have written a novel.

That being said, Enjoy.

—-

Midwifery : Modern Day Practice, Traditional Origins

Written by Jennifer Johnson

Professor Corinne Martin

Holistic Health

Fall 2013

            The word obstetrics literally means “midwife.” It is derived from the Latin word Obstetrix. It was not until the 20th century that allopathic medical professionals began using the phrase “obstetric physician.” [1] In fact, it wasn’t until the 20th century that physicians were delivering babies, and aiding women through their travails. Before that, midwives were the societal standard.

If one was to ask an “average”, modern-day American woman if she would consider giving birth solely under the care of a midwife, it would not be surprising if she reacted in the same way as if you had asked her if she had completed a voodoo ritual that day; She would most likely shy away from the idea.

That is because the concept of midwifery, though making a comeback, has been shunned in American society for nearly one hundred years.

For time immemorial, women have had female attendants during birth. These women were skilled and experienced, taught their craft by the generation before them. These women were known by many names, but by modern standards, these attending women were the first midwives.

In fact, as early as the fifth century, there were Latin manuscripts describing midwives aiding women in pushing and the delivery of babies. There are several texts across the globe from this time period, written in languages such as Sanskrit, Latin, and Greek. These ancient texts described normal births, as well as stillbirths and other complications.1

As more modern practices evolved, more regulation was imposed on midwives and physicians. New York City began licensing midwives in the 1800’s, and by the time the 1920’s arrived, midwives were on their way out of fashion in modern-day American society.[2]

This was a tragedy for women. Unbeknownst to women across the country, the allopathic love of sterility and control ultimately stole the control, empowerment, and ultimately intimate experience of birth from women. There are benefits to birth in a hospital in certain circumstances, to be sure; But the control and intimacy of birth has been removed from the pregnant woman’s hands.

But modern-day midwifery is slowly but surely staking its claim. Birthwise Midwifery School, located in Bridgton, Maine, is one example of the uprising of midwifery in the 21st century.

Heidi Fillmore, who has been a Certified Professional Midwife for 25 years, is the founder and current director of the Birthwise Midwifery School. To be a CPM (Certified Professional Midwife), one must either go through a program to become certified, or go through an apprenticeship. Both routes take several years and are intensive in nature. The standards are put forth by the North American Registry of Midwives; These standards hold midwives to a standard of rigorous, autonomous, healthcare.[3]

There are two different types of midwives. A Certified Nurse Midwive, who has Registered Nurse licensure, and Certified Professional Midwives, who take another educational route.

Certified Nurse Midwives (CNM) have been certified healthcare professionals for roughly 50 years; The CPM certification was only established in the nineties. That is not to say that their professions are dissimilar in that they both aim to deliver healthy babies, or that one is more “proficient” than the other. They are simply different.

The difference is stark between the two; CNM’s practice in hospitals solely, abiding by hospital procedures, and not nearly as autonomous as their counterparts, the CPM’s. CPM’s work in the home or in birthing centers.

Certified Professional Midwives are the primary care providers for pregnant women.  Not only do they aid a woman through labor, a CNM performs all pre- and post-natal care, including blood tests, urine tests, fetal heart rate monitoring; The full gamut.[4]

Allopathic medicine has a variable view on midwifery; While the well-known documentary “The Business of Being Born,” interviews allopathic medical professionals who support midwifery to the fullest extent, this is not the view of doctors and nurses across the board.

In fact, one of the greatest challenges that CPM’s like Heidi face is the lack of cooperation with the rest of the medical community. There are socio-economic factors at work in this issue; Doctors who have gone to medical school and residencies are not only used to being at the top of the medical pyramid, they also view birth as a “condition,” and not a “process” that women go through. In addition to this viewpoint, there is the ever-present issue of female autonomy; 4Women do not need male allopathic physicians to navigate them through a natural, low-risk birth.

In fact, Heidi notes that there are some births – the “good births,” – which she is merely a bystander and a guardian; Monitoring in case she must intervene, but ultimately, not instrumental in the actual delivery of the baby.4

The World Health Organization maintains that it is medically undesirable to encourage a woman to give birth in a supine position. It is the absolute norm and in fact, assumption of nearly all women in a hospital setting, that they are destined to be giving birth to their child laying down with their feet in stirrups.

The reason this is such a common position in the United States is purely for the physician’s ease of access and visibility. Unfortunately, this position not only works against gravity, but also increases the instances of tearing of the vagina, as well as compression of crucial blood flow. 5 The supine position is unnatural; Most commonly, women will squat, stand, assume a hands-and-knees position, or, if given the option, may even give birth in a birthing chair.

The approach of a midwife is to observe a woman while she is in labor, and to suppress making any suggestions as to position; Much like any other mammal in labor, a woman will deliver in the most comfortable and “easy” position that she can find. Heidi notes that 90% of the birthcenter babies are delivered in a semi-sitting position in a birthing tub.4 This author’s personal experience attests to this fact; Having given birth in a “traditional” hospital setting, the supine position was heavily encouraged for a healthy birth.

The observation approach holds true throughout the process for a midwife. A typical prenatal visit will of course monitor weight and heart rate, fetal growth, and urine contents, but also will encourage a close relationship between the midwife and the client. By the time a woman has begun her labor, she will have a comfortable, easy relationship with her midwife. One of the main goals a midwife holds for her client is comfort. A comfortable and confident relationship between a midwife and a pregnant women encourages a healthy, comfortable, and confident birthing process.

Of course homebirthing and the aid of a midwife is not for everyone. Midwives take on only low-risk pregnancies; If a woman is diabetic, has high blood pressure, or is pregnant with twins, she will be referred to a physician. Additionally, a midwife may elect to transport her client to the hospital during the course of labor. The reasons a transport may occur could be that a baby is in breach position, or perhaps if the labor is not progressing in the way that it should be, and the woman is exhausted and disheartened.

Allopathic medical professionals negating midwifery abound on the Internet. It is extremely easy to see how the practice has been discredited for many, many decades, and how the stigma still exists. For every one pro-midwifery Internet post, there are ten anti-midwifery protests (mainly by MD’s on their own blogs.) The information given to the general public is unclear at best; There are allopathic MD’s who completely reject the practice of midwifery, and then there are statistics like those presented in The Business of Being Born that give full confidence to the practice of home birthing attended by midwives.

Additionally, there is some social stigma specifically targeted at Certified Professional Midwives. While CNM’s enjoy hospital privileges and positive relationships with obstetricians, surgeons, and other medical professionals, CPM’s tend to be the black sheep of the medical profession. Their difference in education and their varied views on birth, despite advancements in the past two decades, discredit them in the eyes of many doctors and nurses.

It is easy to see how the information is cloudy for those who are questioning how to approach their pregnancies on an individual level. Should I go to a hospital? Should I hire a midwife? Should I compromise and use a CNM? These questions are hard to answer for anyone, from doctors to midwives to laymen, because the data is so incredibly skewed and biased.

In this author’s opinion, if a low-risk pregnancy is presented, and a trusted midwife is accessible, it would be advisable to explore that option. Certified Professional Midwives have attended highly-educated couples, low-income, non-insured families, and everyone in the middle of that spectrum. There is no stereotype; Not all women who give birth at home are back-to-the-land hippies, although some of them are.

In the end, the truth that prevails is this: Birthing is personal. The choice to call upon a midwife, or to give birth in a surgical suite, is ultimately up to the woman giving birth. The ultimate goal for a midwife is the same as it is for an obstetrician: To ensure a child is brought into the world safely.


[4] Interview with Heidi Fillmore, CPM, Nov 2013**

5 Care In Normal Birth: A Practical Guide, World Health Organization, 1996

**I am happy to post my notes from my interview if anyone would like to read them.

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