Maternal-Child Health Studies from the Department of “Duh,” and Musings on the Disempowered State of Midwifery

Two articles drove me crazy this week.   Let me say at the outset: the title of this post is not a jab at the researchers. I am grateful for their tireless work, in awe of their professional accomplishments, and happy that they are proving what should be self-evident. What I am lamenting is the fact that these things are not obvious to all.

First up is…drumroll…newborn babies can feel physical pain!

Well, now. That is just revelatory, isn’t it?  In an online discussion, I was wringing my hands over the fact that we need a study for this.   And that the headline called this painfully obvious (pun intended) fact “surprising.”   My friend Kristen, who is about to become a mother, responded that she is glad the headline contained the word “surprising,” because otherwise parents and parents-to-be would read the headline, “Newborns Feel Pain Like Adults,” say, “Well, DUH,” and move on without reading the article. She said the headline might spur curiosity as to why that would be surprising, meaning more exposure for the article. That means more parents educated, with specifics, in the event health care providers trivialize the pain their infants might experience during or after medical procedures. In other words, what seems like a maddeningly stupid headline might actually contribute to better informed consent.

OK, I can get on board with that. But still, you know?  It’s just another example of the fact that in maternal-child health care, newborn babies are all too often not seen as sensitive, fully feeling human beings. That mindset affects how we handle everything around birth. Hopefully, this study and article are signs that a shift is underway.

Next is an article from back in January about (yet another) study showing that the more you routinely intervene into the birth process, the more problems you create.

This article contains important information. I’m glad it was published so this information can make its way into the hands of many women who need it. The annoying part is, midwives have been saying all this, and practicing this way forfreakingever. And yet, midwives are not even mentioned in passing in this article about the best practices for which we are exemplary.

That glaring omission in this and other countless similar articles got me thinking. How it is that we as a profession get so little credit for the superb quality of care we consistently provide and the proven outcomes our model of care produces?  Why–and by whom–are we being held back from working the miracles we are completely capable of for public health?

Midwifery care has the very real potential to fix most of what plagues the maternity care system in this country. This is not theoretical—our model of care has a proven track record of achieving superior outcomes in most of the problem areas, both within and outside the hospital setting, and doing it in a cost-effective manner. According to the Cochrane Review, those outcomes include decreased rates of pre-term birth, epidural anesthesia, episiotomy, and vacuum and forceps deliveries. Interestingly, the Cochrane Review did not find a difference in the c-section rate with midwife-led care. This may be because 5 out of the 13 studies reviewed included women with high-risk pregnancies who may have been referred to obstetricians in many collaborative practices, and reviewers acknowledged that more data on possible differences in c-section rates is needed. This is important, because the maternal mortality rate is rising, which is unacceptable and not surprising given the sharp rise in c-section rates, and the fact that c-section increases the risk of maternal death.

In Rhode Island, hospital-based midwifery practices offering 24/7 midwifery care have consistently achieved rates of intervention more in line with the American College of Nurse Midwives’ Benchmarking Project (see “selected clinical outcome measures”), with c-section rates at roughly a third of the national and state averages. We have done so with excellent maternal and newborn outcomes, and while co-managing some of our higher risk patients with our consulting obstetricians, rather than referring all of them out.

There are appropriate times for interventions, and midwives use them, too.   Obstetricians save lives and provide invaluable expertise and specialized skills when medical and obstetrical complications arise. But since most pregnancies and births proceed in a normal, healthy fashion, obstetrics is a higher (and more expensive) level of care than most women require. Evidence continues to mount that the routine overuse of obstetrical interventions is rampant, to the detriment of mothers and babies.

Making midwifery care the primary level of care for all healthy, low-risk women could be a principle factor in solving the maternity care crisis, all while saving health care dollars. It’s kind of crazy that we’re not moving mountains here, because we certainly have the expertise and skills to do so, and the need is so glaringly apparent. On the other hand, it’s not that surprising. What we lack is the money, political clout (since money=political clout), and maybe, dare I say, the chutzpah.

While some of us enjoy satisfying careers in respectful collaborative or independent practices, as a group, we are generally underfunded, undervalued, and disempowered. As one of my most esteemed colleagues has said, “We are a downtrodden lot.” There are many reasons for that outside our control–little things like patriarchy, the very powerful and decidedly midwifery unfriendly medical lobby, and the historical context of the medical takeover of maternity care and the subsequent ostracism and marginalization of midwives (whew, I’m out of breath).

But right now, today, I think we bear some of the responsibility for our own relative powerlessness. I don’t think we have harnessed all our potential power. It seems we haven’t yet decided to “own it” as a profession. Part of that is no doubt due to the discomfort of challenging the status quo, the fatigue of doing so over and over in myriad small ways, and the fear or perceived futility of challenging the dominant system in larger ways. You could write a whole book about the fine balance of fighting enough but not too much, and working effectively within a system while trying to change it. Who even knows where to begin? But whatever the reasons for our collective reticence, we owe it to the women we serve to step into our power and claim it however and wherever we can.

I include myself in this. I’m a mom of small kids, and in the beginning years of my midwifery career, just providing the best, most compassionate care I possibly could while on the job and serving on our state ACNM chapter is all I could muster the time and energy for. But as my kids are getting a little older and parenting no longer feels like quite as much of a full contact sport at all times, I’m feeling ready to do more. I’m not sure yet what that will look like. Stay tuned (and I’m open to ideas!).

Ok folks, here’s to creating a culture where obviously

  1. Newborns are actual human beings with feelings.
  2. Women’s bodies are respected for their inherent beauty, wholeness and wisdom rather than treated as defective machines in need of technological hyper-surveillance and repair.
  3. Midwives’ immeasurable contributions to maternal-child health are recognized, and the power of our collective wisdom and skill–so sorely needed in this country–is harnessed for the good of women and newborns.

I would love to hear what others–anyone, but especially my sister midwives–think of all this. Please add your thoughts in the comments!

© Camille Williams and Wake Up, Mama!  2015

2 thoughts on “Maternal-Child Health Studies from the Department of “Duh,” and Musings on the Disempowered State of Midwifery

  1. Kathy Mercer says:

    Great ideas, Camille! It is interesting that your colleague commented that midwives are “a downtrodden lot”. I hadn’t realized that until clinicals and beyond (into my first – and so far only – CNM position). There’s quite a bit of the downtrodden feeling among midwives and I think that must certainly impact how they (we) treat one another. I guess I pictured myself escaping the lateral violence that plagues nursing when I became a midwife, only to find myself smack dab in the middle of lateral violence on steroids. I saw this modeled in both my intrapartum clinical sites; in each of those sites, there were two CNMs that didn’t work well together. (One site featured the second CNM in direct conflict with – to the point of screaming at – the practice director/owner; the other site featured the practice director and one of the other CNMs in something of a passive-aggressive relationship.) I naively thought none of that would happen to me. I found a few midwives that welcomed me with respect as a sister midwife, but I found at least as many that were very disrespectful and tried (with some level of success) to bring out the worst in me. In fact, I haven’t yet been treated as a midwife colleague in an employment situation and that has been very disappointing. I even chose to teach maternity clinicals in a program where the primary leader is a CNM (not actively practicing); if I knew then what I know now, I would have sought employment elsewhere, because she was pretty aggressive (perhaps passive-aggressive)…but I reasoned that she would be “safe” because she was a CNM. I am not actively practicing as a CNM because I am full-time caregiver for my elderly mom and the CNM lifestyle would not work at this time. In the meantime, I am pondering how I might contribute to women’s healthcare in the future, and at this point, I think it will involve starting something in partial scope (to preserve my own health), with low overhead, and along the lines of functional/integrative medicine (for which I will need additional training, but not necessarily another degree). Bottom line – we may be downtrodden, but we don’t have to tread on the new kids on the block…how much better it would be to nurture the fledgling CNMs among us instead of expecting them to “hit the ground running” (ooo…how I hate that phrase). I saw something recently that I have to remember: Never let your history interfere with your destiny. Women’s healthcare MUST improve and midwives are trained to provide excellent care, but we have to rise above our history to benefit women and their babies.

    Liked by 1 person

    • Kathy, thanks so much for taking the time to share your experience. Despite the frustrations we deal with, I have been fortunate to enjoy warm, supportive relationships with my midwife colleagues. I am sorry you’ve experienced the opposite! I’m sure there are a lot of situations out there like you describe, but thankfully you can also find group practices with women who lift each other up if you ever decide to jump back in.
      Lots of love to you and your mom <3.

      Liked by 1 person

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