Midwifery Care

by Erin Kaspar-Frett, CPM, LM, MSM

Not all midwives are the same, just like not all doctors are the same, or all plumbers. Some claim the title “traditional midwife,” which can mean many things to different people. Some have training only in medical settings (hospitals or medical birth centers) and they would practice similarly to an OB, who likes the latest advances and might use more interventions. 

Most midwives, however, land somewhere in the middle. 

A “traditional midwife” is often trained by those in their community, has perhaps not attended school for midwifery, and may or may not have taken the certification exam. This person could be licensed by the state, or not. They may use only non-medical techniques or advise. As such, there is some debate about what constitutes a tradition for a midwife in our region and who should hold that title. 

A medical-minded midwife generally has attended school, may use interventions regularly (breaking water, regular cervical checks, hands-on delivery only, etc.) and does so with the best interest of their patient or client in mind. 

The term “lay midwife” is often incorrectly used and has mostly been removed from terminology.  

The Midwives Model of Care focuses on communication with the person pregnant and giving birth, while monitoring for changes in status that would warrant more interventions. Each experience is tailored to the person in front of the midwife. Informed choice is often employed. However, these statements are fairly broad and can be applied and interpreted in many ways. How do we monitor? What is it that warrants “more interventions”? And how do we know whom to trust?

I have always loved the phrase  “I trust birth,” and while that is mostly true as a statement, in practice it is more about respecting birth. We have to trust that there will be signs to watch for if human intervention is needed to safeguard the parent or the baby, while knowing that we can’t always control the outcome. I do trust birth but also know that sometimes things happen. As a pregnant person, you can eat all the right things and do all the right exercises and believe all the right thoughts while using all the right affirmation, and still sometimes things happen that are out of our control. This is why our skills must stay up to date.

In our practice, we like to look for pink flags so that we aren’t waiting for a red flag before doing more. Our favorite births are the ones in which we do very little but sit in reverent patience with the emerging family. However, we work hard to keep our skills sharp so we can use them if we do need to jump in because a cord is wrapped, or baby needs help coming out or breathing once out, or to prevent a parent from bleeding too much. We react to what we see at the present rather than ahead of the signs. 

We want each family to choose what is best for them within the bounds of safety. We want to have the time to calmly discuss options, but also to be able to act quickly when needed. 

We also strive to share with clients what the choices are in different settings, especially in the mainstream hospital clinic setting. Because, truly, how can anyone make an informed choice if they aren’t given all the options and as much information as possible with which to make them. 

Birthing choices are about as personal as things can be. Whatever choice a parent makes, we hope that it is made with all the information available.