I recently invited a few midwife students over to watch the season premiere of Call the Midwife. Naturally, when like-minded people are in a room together, the conversation flows. They began discussing their nursing labor and birth rotations at local hospitals, and commenting on the care provision they witnessed. In our big city, there are many large hospitals, some of which gain both loudly popular and unpopular reputations for providers, as well as summations of experiences by women themselves. One of the students began reflecting on a midwife practice in a major hospital (one which I laud as attainable to my own professional goals), and she said as almost an aside, “I heard that even there they don’t provide true midwifery care.”
Do I fault her for saying it? Absolutely not. Do I think it is a micro-moment of the grander midwifery fight that cuts to the heart of my own personal midwife struggle? Absolutely.
What is true midwifery care? What does that even mean? Are any of us individually true or false midwives? Or as a group do some gain a rep of falling off the path of the righteous reproductive health worker? Is true midwifery really the ideal of how any midwife would practice, everything else being equal? If we had our druthers, how would we define true midwifery?
Is true midwifery care the incredible model of birth that The Farm midwifery group has succeeded in achieving? Attention of birth workers internationally, statistics that make your heart swoon, and collaborative integration with the local hospital system when the need arises?
Is true midwifery care the tireless work of the midwives in The Gambia who patiently introduced me to their way of midwifery life? Twin breech birth by candlelight, maternal hemorrhage while blood defrosts under cold running water, assessing for rape in a system without legal support?
Is true midwifery care the research of normal birth, examining the absence of intervention, which perhaps we know intuitively but recognize the need to present academically in this age of evidence informed medical care? Amassing endless research, seeking input of colleagues, and disseminating with an ever-present air of respect for the change process?
Is true midwifery care Centering Pregnancy? Is it home birth? Is it aromatherapy or essential oils? Is it Lamaze or Hypnobirthing? Is it 24/7 call? Is it precepting students? Is it providing abortion? Is it standing up to the medical establishment when we know injustice occurs? Is it delayed clamping? Is it skin-to-skin? Is it breastfeeding? Is it becoming an expert in the field and giving up clinical practice? Is it leaving the profession only when all finances and emotions have been exhausted?
The ever-out-of-reach “true midwife.” Likely what is meant by the question is whether the midwife is able to practice “true midwifery care” in that setting. Semantics aside, unfortunately, the impact and the sentiment of the examination do not change. Each of us is doing everything we can, when we can. And likely the midwives who are examined from afar or from a microscopic perspective already know their struggle, and to point it out cracks the foundation of the work they are already doing to keep it going.
Perhaps we succeed in true midwife moments: true midwife births, true midwife birth control counseling visits, true midwife grieving support, true midwife emotional breakdowns, true midwife collaborations, true midwife abortion care, true midwife precepting. Or, perhaps we succeed in developing a true midwife intention in a difficult system: discussing what could have been different, picking the most important battle, tucking away an idea for how to make it better the next time, finding ways to congratulate people for great work that would have otherwise gone unnoticed. Even further, perhaps many are able to find their own true midwifery practice: where they feel they meet their own desires within the profession, serving the population that fits best with their style, working with colleagues with similarly aligned beliefs, balancing work and life. Each truth is true to each midwife, and the care they provide, day in and day out.
The heart of the matter is, ask any midwife, and each would answer the same. Our work isn’t just our profession: it is our belief system, our way of life, and our mantra for caring for the lives of those around us. To qualify one midwife’s work as not true to the profession then assesses that midwife’s existence within their own definition of their work, and likely those words cut deep. As I have asked before, let us not only believe in each other, but be careful and supportive of each other.
When I was in school, many conversations revolved around “meeting people where they are.” Many would argue that midwifery care does just that, to understand limitations and start there. Why are we less understanding or empathetic with each other’s work? Why do we question that any midwife is giving anything but everything they’ve got? Why do we not believe in each other, or ourselves?
I know enough to recognize that her statement cut deep because of my own examination of where I am currently in my own midwifery process. Examination of the work that I do, work that sometimes succeeds and sometimes fails, and that I hope others, who I respect and consider colleagues, would qualify as worthy midwifery care.
If I described to you my average logistical day, comments about the assaults on the midwifery model would resound. Staccatoed labor interactions in the face of multiple patients. Failed attempts at Resident supervision and interjecting midwifery ideals. Nurses who feel territorial over their role as labor supporters and coach very differently than I might. Double-booked fifteen minute visits, where speed talking has become a necessity. Sacrificing artificial rupture of membranes to stave off starting pitocin. Not having used the hydrotherapy tub, not even once. Sometimes never speaking up even when I know things are wrong, to continue a comfortable work environment for myself. Often (very often) going home defeated by the system, but invigorated by the work and the people I am privileged to serve.
I typically work with people who have never heard of midwives. I spend most of my day filling out public aid paperwork or interpreting for other providers or calling pharmacies for the cheapest birth control. I spend hours bringing people up to basic speed on how their bodies work and how they can control that. I spend a few seconds with each person considering how my care, or another provider’s care, would have been different or better if the patient was privileged in wealth or knowledge or status, and then I work a little harder for each person. And I know that I am not the only one.
I acknowledge that none of us work in a world where a definition exists of, “this is true midwifery care, everything else being equal.” That idea doesn’t exist, because particularly in reproductive health, there is no truth in “everything else being equal.” Access to healthcare, let alone midwifery care, is not equal. Health literacy and understanding of options is not equal. Choice in whether to become pregnant is not equal. Choice in whether to stay pregnant is not equal. Knowledge of different types of care providers is not equal. True midwifery care is not a bar of equal judgement to which we can hold each other accountable, because of the myriad other factors at play.
With great struggle, I am trying to narrow my own definition of true midwifery. I care so, so deeply about this profession, that to think that someone might think less of my work because sometimes I ((inset whatever you consider not “true midwifery” here)) truly breaks me, because my midwifery is me. And while I continue to work toward newer and improved versions of my own true midwifery, I recognize that the midwifery care I provided today is today’s true midwifery. And I acknowledge that you provided your true midwifery, to your best abilities, and I respect and value your work alongside mine. Let us continue to speak our truths, work on them, but appreciate them for what they are.
For me, for now, my true midwifery is doing what I can when I can, and meeting each person where they are.
For you, for now, what is your true midwifery? And can you love the differences that might result in others’ answers?