Before I became a KG Hypnobirthing teacher, I had the idea that midwives were lovely people to have around when you were having a baby, but if you wanted the best knowledge you went to an obstetrician. Over more than a decade that I have been teaching hypnobirthing, my view has changed entirely, and I am in awe of the knowledge of midwives.
The term ‘midwife’ means different things in different parts of the world. There are some countries where a midwife is not medically trained and is simply someone in the community who has experience of birth and is called in to be present at a birth. In some states of the USA midwives are illegal though there is an internet campaign to rectify this. Also in the USA and other countries, an obstetrician attends all births, and midwives are regarded as obstetric nurses who work on the instruction of an obstetrician.
In the UK a midwife is an autonomous medical professional. Her knowledge is superb. She has done a three year degree course (or an 18 month conversion course from nursing), and her area of expertise is normality. She knows how to recognise it, how to facilitate it, when a birth is moving away from normality, and how to get it back on course again. She has the skills to deal with emergencies, and she refreshes these skills in a week of ‘skills and drills’ training every year. She knows when to call in an obstetrician who has huge knowledge and experience when things happen that are out of the ordinary and indeed she would be as keen if not more keen than the mother to make sure an obstetrician was present if an emergency arises.
A midwife can give me full information about everything to do with birth, even about aspects of birth that very seldom happen. The midwives to whom I would turn for knowledge know what normal procedures are, what the evidence is and whether those procedures are evidence based, and what the statistics are about procedures used in birth.
The UK is ahead of most countries in the world in terms of natural birth with the exception of the Scandinavian countries. We still have a long way to go, but we are among the best in the world. The reason for this is that we have a strong, autonomous midwifery profession who are the guardians of normality. This autonomy is frequently under threat, and needs to be guarded with vigilance.
The Birth Place Study (2011) showed that, for women who are healthy and likely to have a normal labour and birth, a woman is three times as likely to have a caesarean operation if she gave birth in an obstetric unit under the care of an obstetrician than in a midwife led unit, almost twice as likely to have a forceps delivery, and 50% more likely to have a ventouse delivery.
Why are experienced and dedicated midwives leaving the profession? It is often the massive increase in bureaucracy and restrictive guidelines. Instead of spending her time being ‘with woman’ she spends a large proportion of her time writing up notes, often for the legal protection of the hospital rather than for the benefit of mother and baby, and performing procedures that she is obliged to perform according to the protocols and guidelines but that her professional experience tells her may not be in the best interest of mother and baby. What keeps a midwife in the profession? It is rare to have a job where you are present daily at a miracle. Midwifery is not so much a profession, but more a calling.
If you want a normal birth go to the expert in normality, the midwife.