Midwives – Trained Labor Professionals (continued)
International Definition of the Midwife
(Updated and endorsed by the International Confederation of Midwives (ICM), June 2011)
A midwife is a person who has successfully completed a midwifery education program that is duly recognized in the country where it is located and that is based on the ICM Essential Competencies for Basic Midwifery Practice and the framework of the ICM Global Standards for Midwifery Education; who has acquired the requisite qualifications to be registered and/or legally licensed to practice midwifery and use the title ‘midwife’; and who demonstrates competency in the practice of midwifery.
The midwife is recognized as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labor and the postpartum period, to conduct births on the midwife’s own responsibility and to provide care for the newborn and the infant. This care includes preventative measures, the promotion of normal birth, the detection of complications in mother and child, the accessing of medical care or other appropriate assistance and the carrying out of emergency measures.
The midwife has an important task in health counselling and education, not only for the woman, but also within the family and the community. This work should involve antenatal education and preparation for parenthood and may extend to women’s health, sexual or reproductive health and child care.
A midwife may practice in any setting including the home, community, hospitals, clinics or health units.” (Adopted June 15, 2011, due for review 2017.) 12
Types of Midwives
In the United States there are several pathways to midwifery education and training. Most pathways culminate in midwifery certification and qualify the candidate for licensing in her state. Unfortunately, even with licensing, in almost half of the United States midwives are not legally allowed to practice their skills in an out-of-hospital environment.
There are several routes to use to become certified including nurse-midwifery and direct-entry midwifery educational programs. The most common types of midwives are listed below, including the three professional U.S. midwifery credentials: Certified Professional Midwives (CPM), Certified Nurse-Midwives (CNM), and Certified Midwives (CM).
Professional Certification of Midwives
Certified Midwife (CM): A Certified Midwife (CM) is an individual educated in the discipline of midwifery, who possesses evidence of certification according to the requirements of the American College of Nurse-Midwives.
Certified Nurse-Midwife (CNM): A Certified Nurse-Midwife (CNM) is an individual educated in the two disciplines of nursing and midwifery, who possesses evidence of certification according to the requirements of the American College of Nurse-Midwives.
Certified Professional Midwife (CPM): A Certified Professional Midwife is a knowledgeable, skilled and professional independent midwifery practitioner who has met the standards for certification set by the North American Registry of Midwives (NARM) and is qualified to provide the midwifery model of care. The CPM is the only midwifery credential that requires knowledge about and experience in out-of-hospital settings.
Direct-Entry Midwife (DEM): A direct-entry midwife is an independent practitioner educated in the discipline of midwifery through self-study, apprenticeship, a midwifery school, a college, or university-based program distinct from the discipline of nursing. A direct-entry midwife is trained to provide the Midwives Model of Care to healthy women and newborns throughout the childbearing cycle primarily in out-of-hospital settings. Licensed Midwives (LM) and Registered Midwives (RM) are examples of direct-entry midwives.
Traditional Midwives: Additionally, there are midwives who—for philosophical, personal, or religious reasons—choose not to add certification or licensure. Typically they are called traditional or community-based midwives. They believe that they’re only ultimately accountable to the women and families in the communities they serve. Some traditional midwives believe that midwifery is a social contract between the midwife and mother and that the relationship should not be legislated at all. Many also believe that women have the right to choose their own qualified care providers, regardless of legal status.
OTHER CONTRIBUTORS TO THE BIRTH PROCESS
OB/GYNs are trained medical professionals who, as part of their training and expertise, hold advanced degrees in managing abnormal pregnancies, labors, and births. They are trained in medically necessary intervention procedures and know how to perform complicated surgeries like cesarean sections and manual deliveries. They also specialize in administering medications and performing other medical procedures designed to save the life of mother and/or baby, should serious complications arise.
Because many physicians are heavily trained in abnormal or complicated pregnancies and births, the vast majority of OB/GYNs have not had the privilege of witnessing a fully natural and uncomplicated delivery. Without having ever witnessed a truly natural birth, they’ve never witnessed a birth completely devoid of medical interventions and in tune with the natural dance of mother and child as they work together in birth. Accordingly, they have no experiential knowledge of truly natural birth on which to base their diagnosis, recommendations, and conclusions. Consequently, these physicians tend to see everything solely through an emergency-medicine lens.
Their role as medical professionals is to help manage pregnancies and births, in the case of serious complications, by addressing acute symptoms and providing assistance only as needed and requested in emergency situations. I do not believe it is a sound practice to put medical doctors in charge of managing uncomplicated natural births—it is a much better use of their time, training, and experience to have them focus on complicated pregnancies and serious life-threatening situations. The primary role of natural, “Islamic” birth caregiving is best left to experienced midwives, doulas, attuned partners, and the mothers themselves who are ready and able to trust their instincts throughout pregnancy, labor, and birth.
The mother holds the honor and distinction of having the most important role in her own pregnancy, labor, and birth. It is her responsibility–throughout her gestation, labor, birth, and post-partum period—to do the following:
- carry her child to term (or as long as Allah wills)
- exercise and maintain her fitness level
- maintain proper rest
- ensure proper hydration
- monitor her healthy diet
- avoid dangerous and/or stressful situations
Pregnancy and post-partum is a complicated time—both physically and emotionally. Hormones are re-regulating, the body is growing and changing, and the knowledge that soon there will be a new little person in her life to care for 24-7 is a lot for some mothers to take in at times.
One of the most important things to remember is that no one has the right to force a mother to do anything. All treatments and procedures should be made with completely informed consent—a fact that gets lost in this age of idolizing medical professionals. Quite simply, no one cares more about that baby than the mother herself and it is important for her, and her husband, to thoroughly read up on, learn about, and further investigate all aspects of their healthy pregnancy, labor, and birth.
For complicated reasons, it is possible for medical institutions to fail to have the best interest of mother and child at the core of their decisions. The sad reality is that, whether we want to admit it or not, hospitals are driven by time and staffing constraints, as well as profitability (which includes avoiding potential losses due to lawsuits). In this way doctors and medical institutions will do everything in their power to convince you that not only was their recommended medical procedure absolutely needed (so you don’t go researching, later on, whether it really was or not). Sadly, given the system in which they participate, they may not have the time, patience, or desire to completely inform you about any known potential risks, possible complications, or alternatives.
This is why it is absolutely important to learn as much as one can beforehand—before one is placed in the situation where one needs to make a decision that has many complex working pieces and potential outcomes. It’s left up to parents to read anything and everything they can to make sure that they know exactly what is needed, and what may not be needed—during pregnancy, labor, delivery, and postpartum. One can make an informed decision as mother and father of a helpless unborn child only when educated in the matters at hand. Again, this responsibility falls most heavily on the mother—as the primary caregiver and protector of her child—and it is a responsibility that must be taken on with full solemnity.
By default, if the mother and father don’t make the time to learn anything about the physiological stages and needs of pregnancy, labor, and birth, then the mother gives up her right to make informed decisions in her pregnancy and labor. By essentially refusing to actually inform yourself, then decisions WILL be made for you by the medical system–decisions that you may end up regretting in the years to come.
The baby’s role in pregnancy and delivery is to grow, stretch, twist, and move into the best position for labor and delivery. Additionally, the baby literally spins through the birth canal as she is being born. In the case of the easiest types of birth, where the head comes through the birth canal first, the body and shoulders twist to fit through the opening and come out with relative ease. Much of pregnancy and labor is a twisting-spinning dance, in which both mother and child work together throughout pregnancy, labor and delivery to ensure that baby has the best possible health, positioning, and stamina to endure the marathon process of being born. The baby also has a right and responsibility to both gather all the essential micro flora, discussed in the documentary Microbirth, from her passage through the birth canal, and to nurse and be close to her mother in the moments immediately following her birth–when she is most awake, alert, and vulnerable.
Birth Locations: Choosing between Home, Birth Center, and Hospital Settings
Pregnant women have a choice as to where they want to birth their child(ren). For many women it’s assumed without question that the best place to birth their baby is in the nearest hospital (or nearest one actually covered by their insurance). Depending on the relative risk of each woman’s pregnancy and birth, she may also be wise to opt for an unobtrusive home birth, or for a birth in a birth-center (something between a hospital and her own home).
The setting of your birth event is as important as the helpers, attendants, and professionals you enlist to assist you. Your setting plays a huge role in both the comfort level of mother, amount of intrusions and distractions from the task at hand (which can prolong labor), and birth outcomes. Surrounded by the right people, it is possible to have a relatively intervention-free birth in a hospital setting; it is likewise possible to have a medically monitored birth at home. It’s all about knowing your state’s laws and regulations, knowing your full options, and making an informed choice about what’s best for you and your family.
Emotional Preparation for Birth
Preparation for birth is not only about the physical aspects, but also about the emotional ones. Women are reminded to have faith in Allah and patience through their pregnancy, labor, and birth. Birth is a natural process and when we leave it up to our instincts, our fiṭra, and when we trust in Allah completely, the outcomes are generally, better regardless of the situation. Natural processes like birth, breastfeeding, healing, etc. are to be encouraged and supported.
Recommended Information Resources
For interested parents I recommend the The Ultimate Islamic Birth Preparation CD—a collaborative project between Nature’s Way and AMANI Birth–is a brilliant resource for pregnant mothers looking for a concise collection of health tips, woman-to-woman advice, and duʿâs for a blessed pregnancy and birth experience. (See my separate review of this CD.)
It’s also important to mentally and emotionally prepare for the pain and uncertainty of birth, especially for new moms. For recommended reading I suggest starting with AMANI Birth, by Aisha Al-Hajjar; and then adding Birthing from Within: An Extra-Ordinary Guide to Childbirth Preparation by Pam England and Rob Horowitz; and Active Birth, by Janet Balaskas—all of which helped me through my own successful unassisted homebirth.
Fathers are encouraged to read these books as well—and to reach out to other more experienced fathers to learn what to expect and how to best support their wives throughout her pregnancy, labor, birth, and the postpartum period. Anticipating what will happen next and knowing what will help—instead of hinder—the process, alleviates some of the fears and uncertainties that can make the experience more scary and painful. Education and a readiness to make informed decisions helps parents feel more confident and ready for the birth of their child.
Knowledge is power. There are many choices and paths to take during pregnancy and birth. These choices are the first important choices that parents must make as the new caretakers of their children.
Mothers must be well-read to make informed and educated decisions about their bodies, their care, and their individual needs—thinking always what is best for their mental and spiritual health, their body, and their child.
Women must remember that doctors are also humans just like themselves, and do make mistakes. Doctors may be experts in the field of abnormal birth, but woman are the experts regarding their own bodies. A woman’s instincts and feelings are valid, and the responsibility for the decisions she makes ultimately lies with her. Whatever important decisions are made, remember to make them with the istikâra prayer for guidance, patience in the process, and trust in Allah.