When a woman is considering having a homebirth and we meet for an
interview, she often asks, "What is the difference between a midwife and an
obstetrician?" Although I can think of many differences both in philosophy
and in practice between us, I have simplified my answer to explain what I
believe to be a very basic difference in perspective. The obstetrician may
say to the pregnant woman, through attitude, words or continual reliance on
technology, "You have to prove to me that you can give birth to a baby."
The midwife, on the other hand, with her attitude that birth is, in most
instances, a reliable event, says to this same woman, "You have to prove to
me that you cannot have a baby!"
The midwife is (or should be) an expert in normal birth, while the
obstetrician must be an expert in pathology. This is exactly the way it
should be. For it is that expert to whom we must turn when we do encounter
the abnormal. I believe that oftentimes, the midwife is more likely to
recognize situations that demand attention than the caregiver who sees all
pregnancy and labor as a potentially dangerous and lethal process.
How have midwives developed such a positive attitude toward the birthing
process? Is it that after watching birth and birthing women through
countless generations, we know that "babies come out"? Of course, we have
also seen birth tragedy, and yet after less than perfect outcomes, we are
able to go on to the next labor with our belief in the process intact.
The first factor paramount to maintaining normalcy in birth and obtaining
an optimum outcome for mother and her baby is our ability to provide both
constancy and continuity of care. As the relationship between midwife and
mother develops during the course of prenatal care, a mutual trust between
the caregiver and cared for brings a sense of safety and security.
Communication becomes forthright and honest, and words and ideas flow
easily between them. When it comes to the time of birth, rarely must we
deal with psychological issues, which may stall or impede labor, since
specters of the past have been met, dealt with and put in their proper
place. The midwife has said to the mother through her manner, her touch and
even with her words through the preceding months: "I will never lie to
you." This is great comfort to the woman with so many questions, meeting
birth for the first time. So many times I have sat with a young woman who
is having her first baby. When her eyes gaze into mine, when I feel her
contractions crashing through her body like tumultuous waves against the
rock, and I know she is doubting her strength to go forward despite her
great desire to complete her task, I say to her, "OK, Suzy, now you will
have to walk on water." She grasps my hand a little harder and replies,
"How far do you want me to walk?" Then, we walk together.
-Valerie El Halta
To read this fine article in its entirety, go to
http://www.midwiferytoday.com/Library/articles/normalbirth.html
Reprinted from Midwifery Today E-News (Vol 2 Issue 11 March 17, 2000)
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