Midwifery has changed considerably in the past fifty years. Along with its elevated profile and legitimacy, the profession has undergone a significant shift towards medicalization. In many cases, midwives work hand-in-hand with obstetricians and hospitals.
For some women, this is a good thing, but for others, who may be expecting midwifery to resemble a holistic, woman-centred relationship in which the mother is the complete authority (as was the case with traditional independent midwifery), regulated midwifery can present unexpected restrictions for women that may not always be made clear to them by their midwives. Independent midwives or birth attendants may also practice in a highly medicalized manner.
It's my conviction that all midwives are drawn to their profession out of love for women and babies. However, prior to committing to a relationship with a particular midwife, be sure to discuss the following points with potential practitioners, to ensure your values are in alignment.
Ultrasound carries risk.
Contrary to what doctors and midwives often claim, ultrasound is not a benign technology. The fact is, high frequency sound waves damage and modify human cells and tissue, and perhaps surprisingly, the use of ultrasound does not statistically improve outcomes. Ultrasound is often presented as a necessary aspect of prenatal care, but increasingly, women are choosing to forego ultrasound altogether and to decline the use of dopplers (a powerful form of ultrasound), in favour of listening to their baby’s heart tones using a fetoscope only--which is totally safe. If your midwife suggests that exposing your baby to ultrasound or doppler technology is necessary, you may want to look into her overall philosophy, or ask yourself why she either isn’t informed as to the risks of ultrasound, or why she isn’t being transparent about those risks. For more about ultrasound, listen to my Free Birth Podcast episode with Emilee Saldaya, as well as the Bauhauswife Podcast Series Parts One and Two
There is no such thing as a “natural” induction.
Castor oil, blue and black cohosh, nipple stimulation, and other schemes to “get the baby out”, are often presented to women as “natural induction” methods. The truth is however, that any attempt to evict your baby from your womb before the confluence of your hormones and your baby's hormones has taken effect to initiate the birth process spontaneously, involves significant risk to your child, and may have the effect of sabotaging your plans for a straightforward physiological birth. Many women are starting to recognize that induction (whether apparently “natural” or not), is, in the vast majority of cases, far riskier than simply allowing the birth process to begin spontaneously. Which brings us to the reality that….
Your midwife may not be “allowed” to attend your home birth if you refuse induction.
Babies come when they’re ready! And a surprising number of babies require a longer gestation period than the “standard” 40 weeks. For example, all of my babies have decided to be born from between 43-44 weeks’ gestation! And they have all been perfectly healthy, with vigorous placentas absent of calcification or any signs of postdates. Sadly though, in many jurisdictions, midwives are obliged to withdraw their home birth support from a woman whose pregnancy progresses past 41 weeks (or whatever arbitrary date happens to be in the books in that location). Make sure you know what kind of conditions your midwife is working under, before you reach your birth-time.
Assessing cervical dilation is dangerous and unnecessary.
Many midwives are still taught that internal exams or cervical checks (the act that involves a doctor or nurse or midwife inserting her hands into a woman’s vagina to measure her cervical opening) are advisable, useful or necessary for most women. This is not the case! Considering that a woman’s cervix may dilate from 1 cm to 10 cms in two hours, or sit dilated at 7cm for 3 weeks or more, there is really no information to be gleaned from assessing a woman’s cervical dilation. The status of a woman’s cervix in a moment in time cannot predict anything about the future of her birth process, or explain the past. What cervical exams *can* do however, is introduce infection into a woman’s body, compromising the health and safety of her baby. If your midwife suggests that a cervical check is necessary as a matter of course, you may want to question her approach or suitability.
Deep suctioning immediately after your baby is born can *cause* meconium aspiration—and bulb syringe suctioning does more harm than good.
In so many videos of hospital births and home births, one will often observe a doctor or midwife putting a bulb syringe down a newborn baby’s mouth and nose, to suction out the mucous. The thing is, there is zero evidence to suggest that there is any benefit to using suction implements to clear a baby’s airways, and in fact, the birth process itself prepares healthy babies very well, for clearing their own mucous, and for life on earth. It is actually vigorous deep suctioning that can *cause* meconium aspiration syndrome, and the most recent NNR/NRP guidelines suggest that even in the case of the presence of thick meconium, suctioning is not recommended. Instead, postural drainage (holding baby on your forearm at a 45 degree angle, while the other hand holds baby’s forehead back a little bit) is far more effective than suctioning, with no ill-effects. Prior to engaging the services of a midwife, ask her how she would approach a situation in which a baby is born with a little bit of mucous or phlegm or meconium apparent, to make sure her response is in line with your wishes.
Fundal height measurements are often highly inaccurate.
Isn’t it funny that on one hand, modern obstetrics is so focused on technological do-dads, while on the other hand, women are still being told that they “measure small” or “measure large” based on a piece of ticker tape being draped across her abdomen, as though this is ever going to provide an accurate assessment of a baby’s growth. Even more disturbing is the fact that women are often sent for ultrasounds (which themselves cannot accurately determine the size or weight of her baby) based on this ridiculously vague and variable measurement! Fundal height can change significantly based on how your baby is lying in your womb, what you had for lunch, and also the mother’s height and weight and body composition. If your midwife is putting undue stock in your fundal height measurement, or using that measurement as a pretext for further interventions in the absence of real evidence of growth issues, you may want to investigate that.
Your midwife may be required to check your baby’s heart tones with a doppler every 30 minutes.
Why would this be a problem? Well, for some women, especially those who are determined to have a spontaneous, physiological birth process, having someone place an instrument on their abdomen every half hour during a journey that can sometimes last for many hours, is unacceptable. Birth constitutes one of the most intimate experiences of our lives, requiring deep concentration and a surrender to a primal limbic state of consciousness. Frequent heart-tone monitoring can be incredibly irritating and disruptive, and can even compromise the optimal unfolding of birth—especially when, for a healthy mother and baby, it is not at all necessary to assess heart tones with this frequency (if at all). Doppler use also presents the same risks as does ultrasound (because dopplers are ultrasound instruments!) Make sure you understand your midwife’s commitments to her governing college, and whether or not these commitments will be in conflict with your preferences.
She doesn’t need to catch your baby.
The ubiquity of images of birth involving gloved hands messing around with women’s vaginas and their emerging babies is astonishing! Did you know that most women are perfectly capable of catching their own babies, and may want to? There is often no ned for a midwife to be anywhere near a woman’s vagina throughout the birth process, even at the moment of birth. If you want to ensure that your baby emerges into your own hands, or the hands of your baby’s partner, make sure you make it clear to your midwife to please keep her distance, as is your prerogative. Check out my recent article on this very topic, here.
NST is not evidence-based, and carries risk.
Many midwives are obligated to refer their clients to a NST or “Non-Stress Test” if her pregnancy progresses past a certain point. The thing is, there is absolutely no evidence to suggest that a NST offers any protection, or statistical reduction of risk whatsoever. Furthermore, the NST involves ultrasound, and carries risks of which many women may not be informed. This is also true for electronic fetal monitoring—zero benefit, significant risk (and EFM has been proven to increase the likelihood of surgical birth). Know that you have every right to decline NST, EFM and all other interventions, even if your midwife suggests them.
GD test is total nonsense.
The Glucost Tolerance Test simply shows whether or not a woman’s body can tolerate a massive spike in insulin. And guess what? Most of us have bodies that don’t appreciate being flooded with liquid glucose and preservatives! Fancy that. It totally makes sense that our bodies would react negatively to that sort of input. My dear friend, midwife MaryLou Singleton has a fantastic analogy: The glucose tolerance test is a lot like giving a pregnant woman a “cigarette test” by forcing her to smoke 16 cigarettes in a row, and then checking to see if her body shows a deleterious impact. “Gestational Diabetes” is not a disease, it’s a set of symptoms that doctors have given a fancy name. Considering that the “treatment” in the vast majority of cases is simply a modification of diet (eliminating processed foods, refined sugars and simple carbohydrates and increasing one’s consumption of quality protein and vegetables) and lifestyle (vigorous daily movement), the whole concept of “Gestational Diabetes” starts to look a lot like the racket that it is.