What is a midwife?

I was visiting with a client yesterday when she mentioned that she had attended high school with a young woman of whose birth I had attended. My mind was a little rattled as I don’t perceive myself as much different from my clients – “you mean you went to high school with Jane and not her mother Sarah (who was my client)?” “Thats right, she said, she just had a baby too!” Wow, I have been attending women while they birth their babies that long…….So, what is it that I have been doing all these years? What is a midwife?

There is currently much controversy in our state about this topic. The controversy concerns mandatory licensure but that’s a different topic. We are all midwives – certified nurse midwives, certified professional midwives, direct entry midwives, naturopathic midwives, lay midwives, traditional midwives, licensed midwives, unlicensed midwives…..have I left anyone out?

What we all do is attend women in labor. I use the word attend very specifically as it points to the direction of the art of midwifery; yes it is an art. Attending a woman in labor consists of directing ones attention in multiple directions simultaneously. The most obvious is towards the laboring mother and her soon to be born baby. Now comes the art – balancing the needs of these two people; the midwife is the one taking responsibility for the welfare of both. She is challenged to allow a woman to listen innerly, following the direction of her own unique labor pattern, to learn each woman’s laboring rhythm then to unobtrusively guide and encourage her when the pattern is deviating from what is safe.

She must have attention also for the wee passenger, whose journey is the actual reason for this amazing gathering of forces, understanding the physiology of his or her passage through the birth canal. What is the constitution of this new being? Can he weather a long labor and hours of pushing and as a toddler fall down multiple times in one day without a peep? Or is he the type that tends to startle easily, the more sensitive one or maybe he has gotten his little head cocked sideways and needs some help getting into a more favorable position. Those posterior babies can make for long labors and longer pushing (see the previous blog).

And then some attention is also needed for the rest of the birth team – her partner and family, her assistants and apprentices.

So how does she do all of this? A midwife must be present to attend. She must be physically present and here is the most difficult task – she must direct and maintain some attention within herself. A divided attention, simultaneously outwards and within. She must be attentive to higher forces that are actually directing the course of events called labor. Hers is to attend and not to decide the course. A midwife knows birth, lives and breathes the birthing process, can visualize the cardinal movements as the baby moves into the birth canal and kicks off has she is born. She knows when to step in, when to hold back, how to encourage and sometimes she must be a bit firm but mainly she attends to the matter at hand, asking herself what is needed now.

M Catherine Schaefer CNM ND