Midwives Fight for The Right to Deliver

As if politicians weren’t busy enough attacking abortion rights and access to contraception, there’s another reproductive choice that’s under threat from conservative lawmakers: the right to choose where your baby is born and with whose help.

Though it may sometimes be eclipsed by the public fixation on the abortion debate, a movement to improve women’s access to midwife and home birth services has been steadily gaining ground in recent years.

Having long championed home and out-of-hospital birth as a less stressful, potentially healthier birthing method, midwives have weighed in on the healthcare reform debate by advocating for a more holistic system of maternity care based on personal “hands-on” help throughout pregnancy and after delivery. The Big Push for Midwives campaign has also advocated for state legislation that enables  birth under the care of licensed Certified Professional Midwives, which is currently unavailable in 23 states as of August 2010.

In contrast to the abortion battle, the midwife’s chief foe is not so much the Religious Right but a medical establishment that has marginalized non-hospital, woman-centered methods of childbirth.

The American College of Obstetricians and Gynecologists recently issued an opinion on planned home births that focuses on the supposed medical risks of the practice, citing a study that the Big Push campaign decries as misleading and methodologically flawed.

Midwifery advocates point to research showing that home births attended by midwives are safe, less invasive and cost-effective compared to conventional hospital birth.

Expanded access to midwives and home birth could dramatically boost maternity care for underserved communities. Citing data showing a recent rise in maternal mortality rates, advocates say the option of childbirth at home is crucial for socially disadvantaged women.

According to one study published in the Journal of Midwifery & Women’s Health, “midwives predominantly serve vulnerable women who are young, poor, immigrants or members of racial and ethnic minorities.” But, the researchers add,

Health system changes are making it more difficult to provide effective care and counseling to disadvantaged women, especially in managed care settings.

Why the hostility to midwives? After all, the practice is the norm in many other countries, and in the U.S. the vocation goes back to the earliest days of the republic—a history lovingly detailed in A Midwife’s Tale by Laurel Thatcher Ulrich.

However, as medicine became increasingly professionalized, the male-dominated world of physicians gradually squeezed midwives out of the mainstream health system. Today, the standard regimen of drugs and emergency rooms dominates maternity care. The movement toward home births marks a subtle rebellion against the inertia of a bloated, profit-minded medical infrastructure.

You could say that a woman is never more vulnerable, or more human, than she is at the point of childbirth. So why shouldn’t the care she receives respect that most delicate of human connections?

Photo via Flickr user treehouse1977 under Creative Commons 3.0.


  1. Midwives are not just excellent care-providers for socially and economically disadvantaged women! They are for ALL women. Both my three-year-old daughter & ten-week-old son were delivered by a midwife. Not all babies delivered by midwives are born at home. I chose to birth my babes at the "alternative birthing center" within a local hospital. I have never felt so cared for, truly heard, respected and supported by a healthcare provider as I have by my midwives. I wish women in our country knew more about this option. ACOG definitely has it out for the midwives. The male-dominated medical model has been trying to marginalize midwifery for 100 years now! Rent 'The Business of Being Born' if you have any doubts. My spouse and I are both medical professionals (I work with high-risk maternal-fetal medicine specialists myself) and can tell you that women in our country are being sold a bad bill of goods. Maternity care in our country is broken. We need more patient-centered, midwifery-model care to solve the problem. Peace on Earth begins at birth! It's your birth…know your options!

  2. Bob Simpson says:

    This has been an ongoing battle for as long as I can remember. Come on people, this is 2011.Why are we even having this discussion. Let the nurse-midwives, the midwives and doulas do their jobs.

  3. Thank you! It's just horrible that legislators are trying to take over not only our reproductive options, but the way in which we deliver our babies. This is just too much!! Why can't they just focus on real problems – like how much it costs to do anything that involves doctors and hospitals???

  4. Thanks for posting Ms.! Despite the fact that the US has the most medicalized childbirth in the world, we rank 29th in infant mortality. Here is a piece by Time Magazine.

    I agree see Ricki Lake's documentary, or check out the books Pushed or Born the USA. If you are pregnant read A Thinking Woman's Guide to a Better Birth.

  5. Nichol-Doula says:

    I disagree that it is conservative politicians trying to curtail our rights. ACOG is bi-partisan in it's attacks. Here in Oregon this effort to harm women by limiting birth choice is being led by the Democrat Mitch Greenlick. So watch the politics when you report on this, because you might just alienate a few of us conservatives or independents that really are concerned with birth freedom and don't think that political party should matter in this discussion at all. The very same people who are pushing for less restrictive abortion laws are the same ones pushing to restrict midwifery access.

  6. I had both my daughters with midwives. The first was born in Britain, where midwife care is the norm. I saw a doctor just once during my whole pregnancy, and that was simply to be introduced to the head obstetrician at the hospital. The midwives attended my labor and delivery in the local hospital. They gave me a cup of tea at the end and cuddled my baby while I took a shower. Then they provided six weeks of follow up care, with a visit almost every day, at my home. In the US, I delivered my second daughter with the midwife service at the Lucile Packard Children's Hospital in Stanford. This service was closed down a few years ago because they didn't make enough money. Though they had plenty of clients, they didn't advise us to use epidurals, or to enter the hospital through the emergency room. They encouraged us to choose natural childbirth, and that just isn't a money maker. Now women in my area have no middle way between a home birth – which I don't have anything against in the right circumstances – and a hospital birth with nurses and doctors and interventions galore. Shame on you, Stanford.

  7. Zannah Merrill-Bernath says:

    While there certainly needs to be birth reform, I think we need to look very carefully at the regulation of midwives. In countries where midwives are the providers for most women, they are regulated and highly educated. Unfortunately, there isn't much support for the path to midwifery in the US, and home births with direct-entry midwives are simply not as safe as births either at home or in the hospital with certified nurse-midwives.

    Something that is equally troubling to me is the undercurrents of marginalization in the natural birth community. This is possibly the most ironic thing, since virtually all NCBers LOVE women and love supporting them too; but when I see my clients dismissed for not breastfeeding, or having epidurals, or I see that "if women just X, Y and Z then birth wouldn't hurt/wouldn't become complicated/wouldn't last as long" so on, so forth, the behavior speaks for itself. We SHOULD trust women- trust them to know what hurts, what they want, and what meets their needs. I feel that the rhetoric too often moves into blaming mothers, and it's hard for me to see without speaking out.

    I'm a doula, studying to become a CNM. I began in the NCB community, and I do love home births, but the more experience I gain and the more research I read, the more I believe the entire birth community, medical and natural, is falling down on the job. Anyway, I fully support MORE regulation of midwives, along with legislation to encourage midwife training and launching into business. More regulation means safer births, more respect from the medical community, which is nothing but beneficial for mothers, and more legitimacy in the public eye.

  8. Hello,
    I so agree with everything you have said!!!!
    I would love to have a baby at home but for health reasons I can"t.
    Thanks for the wonderful work you all do!!

  9. Both of my births were midwife births in the largest town in south GA. I've had a midwife explain she has bad knees, mocking a woman who had asked to labor squatting or kneeling, because it would cause her discomfort. I've had a midwife give me an episiotomy without asking or telling me about it. I've had one exclaim upon coming into the room as I was pushing my baby out that I "needed to quit all that screaming" and refuse my requests for ANY pain medicine. (Bad on me, aneasthesiologists don't show up after hours in Valdosta.) I would've appreciated a local for my 2nd episiotomy but oh well.) And I had a midwife tell me my 150 blood sugars were perfectly normal and my enodcrinologist didn't understand how a pregnant body reacted to diabetes. Just because she's a midwife doesn't mean she'll respect you or your childbirth choices. For #3 I'd love to find a good care provider, somebody who doesn't make me feel like a piece of meat with a baby inside her, and a g-d nuisance besides.

  10. RadiantLux says:

    @TLOgirl, midwives have not been under attack for 100 years. It has been more like 500 years. When universities were founded and men decided to take over medicine. The healers had been mostly women who knew herbal remedies and faced a lot of persecution.

    I read this recently and I think it sums up how women are viewed and treated by our mechanistic model of the body, and how women’s bodies have been traditionally seen as the inferior, defective version of Human. http://www.terrylarimore.com/BirthRites.html

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