The business of midwifery

Money stack with black blank space for text

Contemporary midwifery is to a distressingly large extent about wresting back economic control of childbirth from obstetricians. Midwives have woven a convenient fantasy about how obstetricians “stole” childbirth (and the money it represents) from midwives. That fantasy rests on a profound unwillingness to acknowledge both historical and scientific fact.

It is a historical fact that modern midwifery was made possible by modern obstetrics, which has ushered in an age in which childbirth seems safe. Previously doctors were called to childbirth in only the most dire circumstances. With the switch to routine hospitalization for birth and the routine presence of obstetricians, and, in particular the easy access to pain relief, midwifery went into decline.

[pullquote align=”right” color=””]Women came to prefer obstetrician care because of its safety and increased comfort.[/pullquote]

Don’t get me wrong; obstetricians were only too happy to supplant midwives, but that isn’t the proximate cause for the decline in midwifery. It is a historical fact is that women came to prefer obstetrician care because of its safety and increased comfort.

So midwives have fought back by deriding both the safety and the comfort of obstetrician led hospital birth. In addition, midwives took careful note of what obstetricians offer and offer the exact opposite. The tragedy is that in doing so, they are startlingly willing to sacrifice the safety of babies and the comfort of women.

The midwifery plan to wrest childbirth back from obstetricians is predicated on the following:

If obstetricians medicalized childbirth to make it safer, then midwives would de-medicalize it to make it more enjoyable, and, for added impact, would declare that childbirth was safe before obstetricians got involved.

If obstetricians offered screening tests and measures to prevent complications, then midwives would insist that “trusting birth” was all that was needed.

If obstetricians offered pain relief, midwives would proclaim that feeling the pain improved the experience, tested one’s mettle and made childbirth safer.

If obstetricians whisked babies off to pediatricians to make sure that they were healthy, midwives would claim that skin to skin contact between mother and infant in the first moments after birth was crucial to creating a lifelong bond.

If obstetricians insisted that modern obstetrics was based on science, midwives would accuse them of ignoring science, and if that didn’t stick, they’d insist that scientific evidence was not the only form of knowledge.

If obstetricians placed the highest value on a healthy mother and a healthy baby, midwives would place the highest value on a fulfilling birth experience.

In contemporary midwifery, every day is Opposite Day.

No matter what obstetricians offer, midwives insist that it is unnecessary, disempowering, harmful and contradicted by the scientific evidence. Or as feminist theorists. Ellen Annandale and Judith Clark, authors of the widely quoted paper, What is gender? Feminist theory and the sociology of human reproduction, describe contemporary midwifery:

…the largely unresearched antithesis of obstetrics. An alternative is called into existence in powerful and convincing terms, while at the same time its central precepts (such as ‘women controlled’, ‘natural birth’) are vaguely drawn and in practical terms carry little meaning.

The ultimate irony is that midwives are engaged in psychological projection. They are doing just what they accuse obstetricians of having done. Midwives are trying to wrest childbirth back from obstetricians and give it to those to whom they believed it rightly belongs … midwives themselves.