Midwifery

Midwifery is the health science and health profession that deals with pregnancy, childbirth, and the postpartum period (including care of the newborn), in addition to the sexual and reproductive health of women throughout their lives. In many countries, midwifery is a medical profession (special for its independent and direct specialized education; should not be confused with the medical specialty, which depends on a previous general training). A professional in midwifery is known as a midwife.

A 2015 Cochrane review concluded that "most women should be offered midwifery-led continuity models of care and women should be encouraged to ask for this option although caution should be exercised in applying this advice to women with substantial medical or obstetric complications." The review found that midwifery-led care was associated with a reduction in the use of epidurals, with fewer episiotomies or instrumental births, and a decreased risk of losing the baby before 24 weeks' gestation. However, midwifery-led care was also associated with a longer mean length of labor as measured in hours.

According to a Cochrane review of public health systems in Australia, Canada, Ireland, New Zealand and the United Kingdom, "most women should be offered midwifery-led continuity models of care and women should be encouraged to ask for this option although caution should be exercised in applying this advice to women with substantial medical or obstetric complications." Midwifery-led care has effects including the following:

In continuity models of midwifery care, the midwife-woman relationship is developing over time. The deepened relationship has shown to be of great importance and is in a systematic review described as "the vehicle through which personalised care, trust and empowerment are achieved in the continuity of care midwifery model".

In some cultures, midwifery is the most traditional way of carrying out a pregnancy and childbirth, and it has been conducted for multiple generations. Child birthing women in these cultures, take Zimbabwe for example, feel that health facilities are not as comforting as cultural roots of care. Also, according to the World Health Organization, women should be able to have their children where ever they feel the most safe, so if having a midwife and proceeding with an at-home birth is what makes some women feel safe, then midwifery-led continuity of care might be the best option for them.

History

Ancient history

thumb|right|225px|A woman giving birth on a birth chair, from a work by German physician [[Eucharius Rößlin]]

thumbnail|Icon Birth of Mary (detail). Russia, 17th century

In ancient Egypt, midwifery was a recognized female occupation, as attested by the Ebers Papyrus which dates from 1900 to 1550 BCE. Five columns of this papyrus deal with obstetrics and gynecology, especially concerning the acceleration of parturition (the action or process of giving birth to offspring) and the birth prognosis of the newborn. The Westcar papyrus, dated to 1700 BCE, includes instructions for calculating the expected date of confinement and describes different styles of birth chairs. Bas reliefs in the royal birth rooms at Luxor and other temples also attest to the heavy presence of midwifery in this culture.

Midwifery in Greco-Roman antiquity covered a wide range of women, including old women who continued folk medical traditions in the villages of the Roman Empire, trained midwives who garnered their knowledge from a variety of sources, and highly trained women who were considered physicians. However, there were certain characteristics desired in a "good" midwife, as described by the physician Soranus of Ephesus in the 2nd century. He states in his work, Gynecology, that "a suitable person will be literate, with her wits about her, possessed of a good memory, loving work, respectable and generally not unduly handicapped as regards her senses [i.e., sight, smell, hearing], sound of limb, robust, and, according to some people, endowed with long slim fingers and short nails at her fingertips." Soranus also recommends that the midwife be of sympathetic disposition (although she need not have borne a child herself) and that she keep her hands soft for the comfort of both mother and child. Pliny, another physician from this time, valued nobility and a quiet and inconspicuous disposition in a midwife. There appears to have been three "grades" of midwives present: The first was technically proficient; the second may have read some of the texts on obstetrics and gynecology; but the third was highly trained and reasonably considered a medical specialist with a concentration in midwifery. midwife mentioned among the ancient Greeks.

Midwives were known by many different titles in antiquity, ranging from iatrinē (Gr. nurse), maia (Gr., midwife), obstetrix (Lat., obstetrician), and medica (Lat., doctor). It appears as though midwifery was treated differently in the Eastern end of the Mediterranean basin as opposed to the West. In the East, some women advanced beyond the profession of midwife (maia) to that of gynaecologist (iatros gynaikeios, translated as women's doctor), for which formal training was required. Also, there were some gynecological tracts circulating in the medical and educated circles of the East that were written by women with Greek names, although these women were few in number. Based on these facts, it would appear that midwifery in the East was a respectable profession in which respectable women could earn their livelihoods and enough esteem to publish works read and cited by male physicians. In fact, a number of Roman legal provisions strongly suggest that midwives enjoyed status and remuneration comparable to that of male doctors. In antiquity, it was believed by both midwives and physicians that a normal delivery was made easier when a woman sat upright. Therefore, during parturition, midwives brought a stool to the home where the delivery was to take place. In the seat of the birthstool was a crescent-shaped hole through which the baby would be delivered. The birthstool or chair often had armrests for the mother to grasp during the delivery. Most birthstools or chairs had backs which the patient could press against, but Soranus suggests that in some cases the chairs were backless and an assistant would stand behind the mother to support her.

Early Modern history

Midwives were usually older, married or widowed women with their own grown children. However, this was not an absolute, but a commonly recognized pattern. Many midwives were teenagers or unmarried. Throughout the seventeenth century, the literacy of English midwives was quite high, usually surpassing the clientele base they served. By 1634, most English midwives in London could read, which is important since many of them may not have been able to write, only leaving a simple mark as their signature. By the 1660s, country midwives also had high literacy rates which was remarkable considering female literacy was very low during this period.

Modern history

From the 18th century, a conflict between surgeons and midwives arose, as medical men began to assert that their modern scientific techniques were better for mothers and infants than the folk medicine practiced by midwives.

As doctors and medical associations pushed for a legal monopoly on obstetrical care, midwifery became outlawed or heavily regulated throughout the United States and Canada. In Northern Europe and Russia, the situation for midwives was a little easier - in the Duchy of Estonia in Imperial Russia, Professor Christian Friedrich Deutsch established a midwifery school for women at the Imperial University of Dorpat in 1811, which existed until World War I. It was the predecessor for the Tartu Health Care College. Training lasted for 7 months and in the end a certificate for practice was issued to the female students. Despite accusations that midwives were "incompetent and ignorant", some argued that poorly trained surgeons were far more of a danger to pregnant women. In 1846, the physician Ignaz Semmelweiss observed that more women died in maternity wards staffed by male surgeons than by female midwives, and traced these outbreaks of puerperal fever back to (then all-male) medical students not washing their hands properly after dissecting cadavers, but his sanitary recommendations were ignored until acceptance of germ theory became widespread.

thumb|Midwife's case and contents, Scunthorpe Maternity Hospital, 1920s/30s (North Lincolnshire Museum)

The argument that surgeons were more dangerous than midwives lasted until the study of bacteriology became popular in the early 1900s and hospital hygiene was improved. Women began to feel safer in the setting of the hospitals with the amount of aid and the ease of birth that they experienced with doctors. "Physicians trained in the new century found a great contrast between their hospital and obstetrics practice in women's homes where they could not maintain sterile conditions or have trained help." German social scientists Gunnar Heinsohn and Otto Steiger theorize that midwifery became a target of persecution and repression by public authorities because midwives possessed highly specialized knowledge and skills regarding not only assisting birth, but also contraception and abortion.

Contemporary

At late 20th century, midwives were already recognized as highly trained and specialized professionals in obstetrics. However, at the beginning of the 21st century, the medical perception of pregnancy and childbirth as potentially pathological and dangerous still dominates Western culture. Midwives who work in hospital settings also have been influenced by this view, although by and large they are trained to view birth as a normal and healthy process. While midwives play a much larger role in the care of pregnant mothers in Europe than in America, the medicalized model of birth still has influence in those countries, even though the World Health Organization recommends a natural, normal and humanized birth.

The midwifery model of pregnancy and childbirth as a normal and healthy process plays a much larger role in Sweden and the Netherlands than the rest of Europe, however. Swedish midwives stand out, since they administer 80 percent of prenatal care and more than 80 percent of family planning services in Sweden. Midwives in Sweden attend all normal births in public hospitals and Swedish women tend to have fewer interventions in hospitals than American women. The Dutch infant mortality rate is one of the lowest rate in the world, at 4.0 deaths per thousand births, while the United States ranked twenty-second. Midwives in the Netherlands and Sweden owe a great deal of their success to supportive government policies.

References

Notes

Bibliography

Craven, Christa. 2007 A "Consumer's Right" to Choose a Midwife: Shifting Meanings for Reproductive Rights under Neoliberalism. American Anthropologist, Vol. 109, Issue 4, pp. 701–712. In I.L. Montreal and Kingston: McGill-Queens University Press.
Ford, Anne R., & Wagner, Vicki. In Bourgeautt, Ivy L., Benoit, Cecilia, and Davis-Floyd, Robbie, ed. 2004 Reconceiving Midwifery. McGill-Queen's University Press: Montreal & Kingston
MacDonald, Margaret. 2007 At Work in the Field of Birth: Midwifery Narratives of Nature, Tradition, and Home. Vanderbilt University Press: Nashville
Obstetricians in the city of Groningen.

External links

International Confederation of Midwives (ICM)