This essay is the result of my midwifery studies at Indie Birth Midwifery School. It is composed of a brief history of how birth, midwifery, and the medical industry developed in the United States, from the colonial times until the present day. I will touch on the discussion about midwifery licensure, and end with my vision for the future of midwifery. 

Who Was Attending Births Before Doctors?

Women have been giving birth even before there were midwives. Birthing women are the reason why we are here, not midwives, not doctors. Period. However, birth became a social event when we started inviting others to witness, help, or simply make sure that the space was being kept safe. Perhaps differently than other mammals who tend to hide and be alone for survival purposes, in many cultures around the globe, help and assistance during birth seems to be the norm.

Here I want to challenge the assumption that help and assistance are needed in birth. Unassisted birth has always existed, and is now becoming even more popular among middle-class western women. It is not to say one is better than the other, but considering the mammalian design that our bodies carry, it would be logical to conclude that the socialization of birth interferes with the physiological need for an unobserved and undisturbed birth. 

I argue that perhaps needing assistance is derived from the cultural conditioning forged throughout ages of picturing birth as painful, dangerous, and complicated. The natural physiological blueprint got lost in the collective consciousness, contributing to the manifestation of more pain and complications. Women are being told they do not know how to birth, losing trust in their bodies, and being led to believe they need a savior who will tell them what to do. In addition, many of us strive to reclaim the village and social aspects of birth and parenthood nowadays. Thus, having assistance from midwives, doulas, and close ones in one of the most crucial rites of passage of a woman’s life can be a way to fill in the gap of our highly individualized, private lives. 

It is noticeable that in many cultures women have a tendency to give birth close to their mother, or close to a substitute for their mother, such as an experienced mother or grandmother. This is the root of midwifery. A midwife is originally a mother-figure. The vocabulary often used when referring to the birth attendant translates and contributes to transmit the widespread misunderstanding of the physiological processes. Laboring women do not need a ‘coach’. (Odent, 2001) 

The socialization of birth in Western culture included the gathering of friends and family members during labor, through the first days of postpartum, and until the woman was fully healed. Imagine a culture in which women would come together to help other women in need so she could exclusively focus on her only task of birthing and nurturing her newborn. In this context of “social birth”, men were not part of the birth space, and the midwife would usually be the one attending the birth, while the other women would be in charge of house chores and childcare. This allowed for a close-knitted community of women that went beyond the task of childbirth, but created deep bonds and trustworthy relationships. 

Since men were not invited or even allowed in the birth space, midwives were the carriers of the knowledge, passed down orally through apprenticeship. They developed their practice through careful observation, and would intervene when necessary. They could perform vaginal and perineal examinations, help the woman birth the placenta with fundal pressure, perform a maneuver to turn a breech baby, encourage women to move during labor, and even offer herbal medicine or liquor to speed up labor. 

This lasted until the second half of the 18th century, when the witch hunts in Europe killed most of the midwife population, and doctors began to attend births in the hospitals of the industrialized cities. I am left with the questions: where did this knowledge and wisdom go, once the mere mention of any sort of cure by a woman was accused of sorcery, leading to her trial and murder? What was “normal” and what was “pathological” or “complicated” birth in those times? Who decided which kinds of births midwives could attend, when they were attending all births before medical interventions began? 

How Doctors Took Over Birth

How did doctors become more credible than midwives to “manage” birth? In my view, it was fundamentally a shift in the collective common sense that: a) birth was no longer normal, but a complicated, painful, and dangerous event, and b) the authoritative knowledge – the intuitive wisdom that was passed from woman to woman, from midwife to midwife – was now less valuable and credible than the scientific heroic knowledge of the doctors. 

In the 1960’s, Stanley Milgram, a Yale psychologist conducted a series of experiments. He found that participants were willing to inflict pain on another person simply because they were being told to do so by an authority figure. Even though (male) doctors were not nearly as skilled or knowledgeable in childbirth as any other midwife, they succeeded to overtake the role, turn it into a profession, and practically erase midwives from the picture simply because they self-established their “authority”. 

One doesn’t really need to learn the history to reach a logical conclusion: wisdom that had been passed down for centuries from woman to woman could never be surpassed by a few decades of men studying the female body in a cartesian way. Physicians were only called to births in extremely complicated situations. Other than that, birth was still a women-only event, and midwives were carrying on all the procedures. 

It was the schooling system that helped legitimize the self-proclaimed “authority” of doctors. In the late 1700’s, men began to attend births in England, and many upper-class males were traveling from America to study medicine in Europe. This notion of literate “men of science” was becoming popular among the middle and upper classes.  Male doctors began teaching and writing about midwifery, which not only created the opportunity to be invited into childbirth, but also ingrained the rivalry between the scientific male knowledge versus the female oral tradition among the population. 

In the 1900’s, the Rockefellers and Carnegies invested and created a monopoly of standardized medical education in the United States. Through their “organized philanthropy”, the ruling-class shaped the social, cultural, and political aspects of the population. Their agenda included a “medical reform”, and the creation of a “medical profession”. They donated millions to hand-picked medical schools, and made sure to put an end to all the other community-based or smaller institutions that would not comply with their model of education (the Johns Hopkins model). This made it even harder for women or the working-class population to attend medical school.

However, as stated before, the truth was that the newly graduated doctors were not well-equipped at all to serve birthing women. Some doctors were humble enough to admit that, and instead of practicing alone, would prefer to collaborate with midwives and even learn from them. But for others, it was intimidating and demeaning to submit to a woman’s knowledge.

Later in the 18th century, the invention of the forceps was popularized. Doctors were using them widely, but midwives were “not allowed” to use them, since they didn’t have the medical training to do so. Thus began the interventionist model of obstetrics. Aside from forceps, they would also use ergot to induce uterine contractions. Although midwives had also been using it in their practice, it was only as a last resort, while physicians were prescribing it routinely such as the use of pitocin nowadays. 

They also performed other procedures taught in medical schools, such as bloodletting (even when a woman was hemorrhaging), using opium for the pain (later ether and chloroform), cathartics for cleansing the bowels, tobacco infusions for cervix dilation, breaking the waters to speed up labor, and they would also kill and remove the unborn fetus when they thought the birth or the baby didn’t have a chance to succeed. All of this with the scientific stamp of approval from their medical degrees.

How Birth Moved to Hospitals

Still, birth was taking place mostly at home, and midwives were the main attendants, with doctors being more frequently requested in upper-class homes, and only with the consent of the woman, since men in the birth space was still seen as taboo. But as industrialization and urbanization rose, the women’s support networks dissolved, almost completely disappearing by the 20th century. In addition, medical professionals were spreading the scientific view of birth as pathological and unsafe, pushing families to choose medical interventions in birth more and more. Midwives were slowly losing importance in birth, as more families chose doctors over them. 

The solution presented was the hospital, where you could receive care from nurses and doctors. For doctors, this represented profit and convenience: they didn’t have to travel to see patients at home anymore, but could handle a high volume of patients in the same place. They had more “control” over birthing women, facilitating the use of surgery and anesthetics. For women, this represented isolation and complete loss of autonomy in childbirth. For midwives, their use was reduced to areas in which hospitals and doctors were not available, mostly in rural or poor areas. Their knowledge was undermined by the new and appealing scientific approach to birth.

Upper-middle class urban women were freely choosing to give birth in this setting, since their advantageous socioeconomic situation would provide them with the safest, most luxurious, and scientifically advanced care —or so they thought. Furthermore, anesthetic use was becoming more common, and desirable by women. The promise of a pain-free birth was another motivation for choosing a hospital birth.

However, births in hospitals were neither safe nor pain-free. Doctors only accepted the germ theory in the late 19th century. Until then, women in delivery rooms were dying of infections because doctors would refuse to wash their hands. But after accepting that theory, they took it to an extreme. First, the argument that the home could never be sterilized brought more birthing women to the hospitals. Second, hospitals established extremely aggressive sterilization routines at the time of admission, which included: an enema, a vaginal douche with bichloride of mercury, washing her hair with kerosene, ether and ammonia, and her nipples and navel with ether, and sometimes having their pubic hair shaved. Some of these procedures continued throughout labor. These measures, not surprisingly, led to an epidemic of maternal deaths. Even though women were choosing the “safest” choice, maternal deaths were increasing. In 1915, approximately 60 mothers died for every 10,000 live births, and in 1930, it went up to 70. 

The promise of pain relief was also causing more harm than good, with serious adverse effects for the mother and their children. Twilight sleep (a combination of scopolamine and morphine) was first used in Germany in 1910. It was thought to be superior to ether or chloroform because it did not affect muscle function. But the effectiveness of the drug was not verified by many other doctors. Women were still having memories of the pain, and while not fully conscious and unable to control their impulses, they would be violently thrashing their bodies and needed to be strapped down. The drug would also cause asphyxiation and eventual death to babies. 

While there was no consensus among doctors to adopt the drug or not, there was one point in which they could all agree on: anesthetics was a way to “control” birth, bringing more births to the hospital. Aware or not of the adverse effects of the drug, some women were demanding the right for a pain-free childbirth, which became widely adopted until the late 70’s. The result was a drastic inversion of the numbers: in 1905, less than 5% of births took place in hospitals; in 1945 this number jumped to 78.8%, and in 1960, it was over 96%. 

Modern Midwifery

I had this interesting interaction with a midwife that I met the other day. Here’s how it went:

—Oh, you’re a midwife? I’m studying midwifery!

—Really? Where? 

—It’s an international online school for traditional midwifery. I don’t want to be a nurse. 

—Oh, so… like a… doula?

—No, like… a midwife.

End scene. 

This situation made it obvious to me that the term midwife has been completely co-opted by the medical system. Think midwife, think nurse-midwife. Think birth, think hospital birth. How did this happen? 

With the advent of high-volume hospitalized birth and an increasing urban population, paired with the decreasing number in licensed doctors and midwives, another role was demanded. Doctors couldn’t waste their time sitting by every patient’s bed, or wait for long labors to conclude. They needed extra hands in the hospitals, a crew that would take care of the small procedures while they could focus on surgeries and diagnosing. 

While in England, Germany and most European countries, the midwife was given training and turned into an independent occupation, in the United States, obstetrical care was not interested in legitimizing and improving their services. Their main interest was in maintaining the monopoly on the growing birth industry.

The solution that seemed to please both doctors and middle-class women was nursing. The nurse was the perfect combination of a wife and a mother. She was a wife to the doctor, submissive and obedient; and a mother to her patients, caring and attentive.

When women had a place in medicine, it was in a people’s medicine. When that people’s medicine was destroyed, there was no place for women—except in the subservient role of nurses. The set of healers who became the medical profession was distinguished not so much by its associations with modern science as by its associations with the emerging American business establishment. (Ehrenreich, 2010)

Thus, by succumbing to what was left of medicine, nurses further legitimized the authority of male doctors over midwifery, while also renouncing midwifery altogether, since birth was now to be dealt with under a completely medicalized paradigm. 

This model continued at full-force until the 1970’s, when less than 1% of babies were being born at home, and midwives were almost nowhere to be found. It was during the “new age” climate of the 70’s in the United Stated that middle-class women “rediscovered” home birth and midwifery. They would seek out the “granny” midwives to attend their births, or ask a trusted friend to assist them. Women were teaching themselves about the physiology and anatomy of birth, attending each other’s births at home, and becoming midwives themselves. 

Certainly, this wouldn’t last long until doctors began to fight for their monopoly again. At the same time, women were now more equipped to organize and fight for their rights, inspired by feminism and benefiting from more freedom. There were now more characters in the scene apart from the nurse, the doctor, and the patient: middle-class, educated women who were choosing home births, and the self-taught midwives who were responsible for the reemergence of the profession.

The Battle Against And For Free Midwifery

The efforts to restrain or completely eliminate midwifery began long before doctors and hospitals were the norm. Before the 1400’s, midwives, healers, shamans, and herbalists had been the original keepers of the wisdom of life and death. They were the true scientists, seeking to understand phenomena that were beyond just logical explanations. They were empiricists, using their senses to understand the human body, plants, and find cure. In their practice, they took into account the full spectrum of human existence in relationship with their environment.  

It was witches who developed an extensive understanding of bones and muscles, herbs and drugs, while physicians were still deriving their prognoses from astrology and alchemists were trying to turn lead into gold. So great was the witches’ knowledge that in 1527, Paracelsus, considered the ‘father of modern medicine,’ burned his text on pharmaceuticals, confessing that he ‘had learned from the Sorceress all he knew.’ (Ehrenreich, 2010)

But there has always been an ongoing agenda for erasing the guardians of this wisdom that culminated in the witch hunts in Europe, organized and financed by the Church and State, more evidently between the 1500’s and 1700’s. The campaign not only instilled a deep sense of fear and terror in the masses, but it also killed women and children under the faintest accusations. Soon, women were banned from practicing any sort of healing, under the threat of being executed.

Healing, in its fullest sense, consists of both curing and caring, doctoring and nursing. The old lay healers of an earlier time had combined both functions, and were valued for both. … But with the development of scientific medicine, and the modern medical profession, the two functions were split irrevocably. Curing became the exclusive province of the doctor; caring was relegated to the nurse. (Ehrenreich, 2010)

In the colonies, the climate was different: midwives were still respected and even received compensation for their services, such as housing and sometimes money, while serving the whole community, both rich and poor. They traveled long distances to attend births, and often stayed with the family until the woman was fully recovered. But eventually they also were slandered and cast out of their roles as the doctors forced their way into birth and sought to eliminate competition. They were called “dirty”, “ignorant”, and “incompetent”, accused of and charged for killing and hurting mothers and babies.

As the medical industry was growing, obstetrics became a profitable branch. Doctors were determined to restrain midwifery and home births, and finally establish a monopoly on birth. They did this by using law and certification. They organized and created the American Medical Association in 1847 and started lobbying for laws. They eventually conquered medical licensing in almost every state, which made it more difficult for doctors and medical schools to exist, thus elevating the demand and the prices for their services.

A recognized profession is not just a group of self-proclaimed experts; it is a group which has authority in the law to select its own members and regulate their practice, i.e., to monopolize a certain field without outside interference. … Professionalism in medicine is nothing more than the institutionalization of male upper-class monopoly. (Ehrenreich, 2010)

  Doctors soon started getting political power by running for Congress, and AMA became an arm of the American Government, with the power to regulate public health. Soon, they attacked midwives and succeeded to outlaw midwifery state after state. Still, many midwives, in particular the “Granny” and black midwives continued to practice, especially in rural areas with no access to hospitals and doctors. Although they were still in the target group of “old ignorant” midwives, they were tolerated by some of the doctors who recognized their importance and necessity in their communities.

The efforts to restrain midwives were polarized between those who sought complete elimination, in the name of scientific advance and professionalization, and the ones who believed midwives should be trained to fulfill their standards of the profession in order to acquire their licensing. Their strategies ranged from creating programs to instruct and educate midwives according to their medical paradigm, to making licensing extremely difficult to obtain or renew. As a result, licenses were being denied where doctors were available, midwives were being forced to retire, the areas in which they could practice were being restricted, and women were instructed to seek a doctor’s permission for having a midwife-attended birth. 

The legal battles on licensure, and court cases prosecuting midwives continue to this day. Despite the incessant efforts to regulate and restrict midwifery, the profession remains alive, whether by adhering to the State’s norms of practice, or by practicing without a license. Still, even among midwives, there is no consensus whether the profession should require licensing.

Those who are in favor of licensure argue that it guarantees the quality of care, protecting the consumer with a standardized treatment. Licensing midwifery implies: a) requiring a certain set of skills, b) a scope of practice based on medical standards, and c) limiting the care only to births that range within “normal” according to the medical standard. In those terms, midwifery would be “safe” to practice, and all that falls outside of that category should be referred to a medical practitioner. 

However, the standardization of skills and education does not create better midwives; instead, it only makes them compliant to the medicalization of birth. Midwives who are self-taught and apprentice with a preceptor, attending births from beginning to end, are arguably much more skilled and prepared to handle both uncomplicated births and emergencies on their own, compared to those midwives who work in shifts, attending many births at the same time, under a doctor’s supervision who will take over the patient’s care if there is any sign of complication. 

Limiting the midwife’s scope of practice based on what doctors are willing to concede is a clear impediment for the full freedom and development of midwifery. There is no logic in another profession —that claims to be superior—  trying to regulate another. Using this logic, it would make more sense for midwives to regulate doctors, since the former existed way before the latter. But the fact is that these are two different fields of knowledge, stemming from completely different approaches to birth and the female body. 

Similarly, the definition of “normal” in birth according to either side is not necessarily the same. Therefore, accepting the medical definition is not contributing to the comprehensive skills of midwives. It is clear that the arbitrary definition is favoring the medicalization of birth, misleading families to hospital births, and putting midwives at risk for attending such “abnormal” births. 

It is understandable that midwives would seek a dialogue and partnership with the medical industry. After all, technological advances such as surgery and medication are also valuable tools that should be available to every woman. But the promise of “humanization” of birth can lead one to think that it is possible to change the system from within. Those who believe that the system is “broken” are failing to realize that it has always been set up to keep the power in the hands of those who run it, for their own benefit and profit, not the consumers’. As De Vries puts it “licensure laws do not exist solely for the protection of the public… they exist for protection of the profession.” (De Vries, 1996) Another misleading idea is that by licensing midwifery it becomes more accessible to the poor. But those seeking midwifery care and births outside the hospital nowadays are usually educated, self-responsible citizens who are aware of their choices and the harms of medicalized birth. 

Underlying the issue is also the search for respect and equality within the professions, as if a midwifery license could be as valuable as a medical license. But in truth, licensing only further reinforces the authority of doctors over midwives, who now renounce their freedom of practice to submit to the rules and impositions of the medical model. 

Paramedical groups view the monopolistic benefits granted to physicians by licensure, and assume that similar benefits will accrue to them. Unfortunately, these aspirations rest on a naive view of licensure. Physicians were the first medical practitioners to obtain licensed status, and they were free to define and thereby dominate health care. As their political and cultural power has grown, they have become less willing to surrender any authority to ancillary medical professions. In this climate, others who wish to be licensed must be ready to accept control by physicians. (De Vries, 1996)

The result is that certification and licensure profoundly shape the birth scenario. It influences the practitioner, the client, their relationship to each other, and the birth itself.  

Generally speaking, the licensed practitioner: a) has a commitment to the regulations that they are working under, not to the family’s choices; b) is seen by the clients as more competent (because of credentials), and therefore expected to be responsible for the outcomes; c) is trained to manage abnormal situations instead of encouraging and nurturing healthy physiological birth; d) acts as the “substitute” for the doctor, able to offer more “humanized” care; e) is allowed to collect payments and practice publicly. 

In contrast, the unlicensed practitioner generally: a) is committed to the family, and uses her own discernment, knowledge and skills to practice (not regulations and medical standards of care); b) is sought out by educated clients who are willing to take responsibility for their choices; c) is trained to promote physiological birth, and see birth and the clients through a holistic perspective; d) might not have the collaboration of doctors and hospitals; e) might not be able to collect payments or advertise openly. 

Although licensing cannot measure the quality of care offered by the practitioner, it can certainly delineate the structure under which the service is being provided. Choosing a licensed midwife means choosing care under a system that defines the provider as the expert, and therefore, is responsible for the birth. The client has little to no autonomy to decide over the procedures, and is subject to the “expert’s” opinion and protocols. Choosing an unlicensed midwife means taking responsibility for the outcome, having freedom to decide about interventions, and accepting the midwife as a witness and not the savior. The ultimate decision-makers should not be organized doctors, politicians, or even midwives, but clients. The birthing families are the ones who will suffer all the consequences of their choices, and whose health are at stake. 

For the most part, certification eliminates consumer evaluation of medical practitioners. The typical client simply accepts a state-issued license to practice as a judge of ability. Where such licensing systems do not exist, as with California’s lay midwives, this respon­sibility remains with the client. (De Vries, 1996)

On the client’s side, this kind of arrangement demands extensive research and autonomy to understand birth, assess one’s own health, and make a conscious, informed choice about the kind of care they want. On the practitioner’s side, it requires complete transparency about their skills and abilities, and respecting the choices of the family concerning the whole process.

The Future Of Midwifery

In this final section I will argue about the key points that I believe should carry midwifery and birth in a positive direction. These are:

• Depoliticizing birth and women’s bodies. Women supporting women freely without interference or regulation of the State or any other institution.
• A critical mass of parents who:
  • see birth as a physiological, natural, private, spiritual, and sexual event;
  • hold ultimate responsibility for the outcomes, and know they are the ultimate decision-makers throughout the entire process;
  • know that the medical system is in its majority an industry with the purpose of generating profit to the elites, not health to the consumers;
  • are aware of the fact that pathologies in pregnancy and birth are rare, often easily prevented, diagnosed and treated with minimal medical interference, and can be open for interpretation.
• A critical mass of medical professionals who share the same values and goals towards birth, babies and birthing women as midwives. 
• Deconstructing the authority role of birth attendants and the savior paradigm. The mother is the expert of her own birth. Birth attendants and medical teams cannot always avoid undesirable outcomes.
• Home birth as the norm, leaving doctors and hospitals to emergencies and high-risk cases. 
• Redefining risk and “normal” birth, not based only on inconsistent studies and data, but looking at the individual in its totality, uniqueness, and context.
• The first step towards sovereignty is educating oneself on: conception, pregnancy, birth and postpartum; sexual anatomy and physiology; contraception and fertility. 
• Making birth social again by creating support networks for pregnancy, birth, and postpartum. 
• Creating or upgrading technology that generates the least negative impact on the mother-baby bond, on the physiological process of pregnancy, birth and postpartum, and on the emotional, psychological, biological, spiritual, and neurological aspects of all involved. 
• Using technology and interventions strictly when necessary and only with the informed consent of parents.
• Recovering the ancient technologies and wisdom that are still preserved in some traditional practices.

A new look at birth

This essay has demonstrated how midwifery went from a tailor-made, individual-oriented practice to a high-volume, standardized model. We went from seeing birth as a natural event that is part of the cycle of life, growth and death, to categorizing it as abnormal and pathological. The former requires patience, careful attention and respect for the nuances of how it presents, and a nourishing approach that fosters life and health. The latter is focused on controlling and managing the timing and the nature of the process, avoiding death at all costs by using dangerous interventions, and setting arbitrary rules for what is considered “normal”. 

It is clear that the future of midwifery is tied to the future of birth and women. Much has been said about the “humanization” of birth within the medical field. Although that may sound appealing, what is needed is a profound change in how birth and women’s bodies are treated, not just cosmetic adjustments that only aim to attract more clients for profit, while continuing to operate in the underlying belief system that birth is dangerous and women’s bodies are defective. In reality, “humanization” of birth is another marketing strategy that allows for the medical system to branch out to other target groups. Such a strategy can be seen in facilities such as birthing centers that are still operating under hospital protocols, and in promising tours and interviews that serve merely to close deals.

The future of birth lies in the hands of those who realize the deception and the abuse that have become normalized in this industry. It is a mass awakening of self-responsible, educated individuals who are willing to take full charge of their health, bodies, babies, and families. People who are willing to make decisions about all aspects of their lives, and consciously choose to step further and further away from the control of the elites. In this logic, health practitioners and midwives can provide advice, but informed consent becomes mainly the responsibility of the client. This requires actively researching and looking at one’s options, knowing that they are the ultimate decision-makers and responsible for their choices. 

These people understand birth is not just a physiological and natural event, but spiritual and sexual too. They honor the sacredness of their own life force, manifested from conception, and resulting in the continuation of their legacy through their kin. They hold birth as a rite of passage, a transformational experience that requires preparation, devotion, proper guidance and support. They value the midwife as their trusted friend, as a keeper of knowledge and wisdom, and the bridge between the family and their community. They know that the role of the midwife in this context is not to be the responsible for the outcome of their initiations, but to be the space holders for whatever unfolds. 

I believe the future of midwifery is also tied to the future of obstetrics. Although it is not my place to talk about the future of obstetrics, I argue that further separation between the two only creates more obstacles for birthing women and midwives. Both have their importance and should work together to serve birthing families. Dialogue is needed between the two areas, in a way that they can understand and respect each other’s place. Doctors can work in alliance with midwives, as long as they share the same values and goals towards birth, babies and birthing women. 

When this mass awakening is successfully implemented, the medical industry will become powerless without their consumers, making way for a new medical paradigm to be initiated by those who are also envisioning a new model of care. A patient-centered model, that operates in reverence for the human body, and encompasses the whole of the individual. The industrial paradigm will be left behind, and people will no longer be removed from their safe familiar nucleus to be thrown onto conveyor belts of medical routines and protocols. Midwives will not need to transfer care based on fear of prosecution or regulations from institutions, but based on her discernment, skills, and the informed choice of the parents. 

In this paradigm, pregnancy and birth will no longer be pathologized. Perinatal pathologies will continue to exist, but must be defined and diagnosed carefully, taking into account each individual’s circumstances. Treatment and other medical procedures should be advised, never imposed onto the patient. Emergencies, high-risk, and diagnosis can have different interpretations depending on who is assessing them, and can change from practitioner to practitioner, from client to client, situation to situation, and also depending on their set of skills, knowledge and resources available at one given moment. 

Moreover, midwives, medical practitioners, and clients often differ in their assessment of and opinion about risk and normal birth. The fact is that scientific studies and data are largely inconsistent, and insufficient to support evidence-based care. It often results in protocols and routine procedures that are limiting the midwives’ and women’s freedom, and in the cascade of interventions that generate even more harm. Therefore, there is no one single best course of action, but a range of options based on what risks one decides to take according to one’s own guidelines of care and health. 

Finally, scientific research and medical practice will be aimed towards preventing disease, avoiding interventions, and cultivating health and nutrition. New technologies should be designed to generate the least negative impacts, and interventions should take place with informed consent and in strictly necessary situations. Ancient technologies and wisdom, that not only cure but heal, can be restored, and used to prevent more aggressive medical and pharmacological ones.

Freedom for women, freedom for midwives

Birth moved from the female midwives’ hands, to the male barber surgeons’, then to male midwives’, and finally male obstetricians’. It was pushed from the calm, private, familiar home, to the invasive, strange and lonely hospital. The gained authority of modern science, and the economical and educational monopoly of the medical industry, combined with the cultural and societal changes after the industrial revolution were enough to make us forget about the importance and the role of midwives. 

Women supporting other women for the sake of solidarity, as a mission and vocation was not profitable or acceptable within the capitalist, patriarchal model. The answer was to break apart networks, heavily attack, and eventually erase midwives. Nursing emerged as the new field for women who wanted to be in healthcare, transforming the role of midwives into a profession, compliant and subservient to the medical hierarchy. Formal recognition from institutions such as degrees, licensure and certification became another tool to control and coerce midwives. The irony is that the majority of the population that midwives serve is not aware of the difference between a nurse-midwife or a traditional midwife, let alone what each type of certification represents. 

Whether we should continue licensing midwifery or not, I would rather leave it to the State and the medical system to waste their time on trying to control what is beyond their capacity. Even though direct entry midwifery is illegal in 12 states, there are —and will always be— women serving other women without needing the degree from an institution or authorization from the government. With or without licenses, countless women have been accused, slandered, murdered, thrown in jail, trialed, while their peers and clients continue to support and believe in them. Who is this battle for? Who is trying to win anything here? 

As an aspiring midwife, my only commitment will be to the families and my own integrity. History taught us that by joining the fight, we can only get hurt. That is because the nature of the system is patriarchal and capitalist. There is no point in trying to win a battle within a system that is founded on giving less power to women, and profiting at any cost. By seeking recognition from them, we are still looking at midwifery from their patriarchal, cartesian lens, instead of reaffirming our practice based on our own core values, beliefs, and wisdom, and on what women decide is best for them. Even with their best concessions we would still be at the very bottom of their hierarchy. We would be settling for crumbs.

I believe the future of midwifery is freedom of practice and freedom of choice. I stand for no regulation and complete legalization of midwifery. The power should be brought back to the people, not legislators, policy makers, or billionaire industries. There is no logic in arbitrarily regulating and standardizing birth according to laws proposed by those who are not interested in freeing, but only in profiting and exploiting the female body. 

I support the freedom of every individual to choose the kind of care they want at any circumstance. I believe in every individual’s discernment about their own abilities, needs, boundaries, and desires. I believe in self-responsible, accountable adults who can educate themselves and make informed choices, understanding their limitations in knowledge and skill. I believe in full-spectrum care, which includes the acceptance of all outcomes and access to all alternatives available. I believe women’s bodies and their babies are not to be regulated by the State, especially not by the white male elite.

When birth is labeled as a pathology, it becomes a public health issue. This is the strategy they use to create another branch for the industry to profit from. By creating the problem, they can control the population, install fear, and present the “solution” that will “save” us all. A few people who die of the flu is not a public health issue. But by labeling it as a “pandemic”, suddenly there are millions of patients, or potential patients, that the industry can save. A few women and babies who have serious complications (that are not stemming from malpractice and cascades of interventions) is not a public health issue. It remains an isolated event that happened in a particular situation with individuals who probably had completely different factors that led to the same diagnosis. Birth is a private health issue. It is no one’s business how a woman chooses to give birth. She is the only one who can decide who enters the sacred space of her pregnancy and birth. 

Making birth social again

I believe midwives are more than birth attendants. Our mission involves building community, creating connections between women, between families, where life can thrive, and death can be honored. Where midwives are caring, teaching, listening, and healing, they are bringing back the social aspect of birth. This doesn’t mean that the birth space shouldn’t remain a private and intimate space. In fact, the mammalian instinct to be alone during birth should be respected and encouraged for optimal outcomes in my opinion. But knowing that a woman can birth and come back to her close ones either to be celebrated or to be held in her grief is where the importance of the social ties are. 

A midwife is the epicenter for the transformation of the birth paradigm. They carry the power of influencing their community by being the example of care that women deserve, by educating families, preserving the mother-child bond, advocating for the decisions that the parents make in such a crucial moment of their lives. The midwife has the power to maintain intact and to repair the family unit and the community ties. 

Midwives are invited into the most intimate and vulnerable space of the family, and can serve as a mirror, a soundboard, or a generator of change. They witness a wide diversity of families, connecting to each of them on a deep and personal level, having a comprehensive and holistic view of the individuals they are working with. They are not only assessing perinatal health, they are also observing socioeconomic aspects, relationships, trauma, beliefs, fears, grief. Their lived experience becomes a database for understanding the community’s context, patterns, trends, and needs. In this way, midwives are essential agents of change in the social fabric. Acting at grassroots level, they are able to organize the community to foster the transitions of pregnancy, birth, and postpartum.

Some of the many ways they can create support networks are:

• Organizing gatherings for families, mothers, children, fathers, birth workers where they can discuss common concerns and create bonds.
• Holding space for resolving perinatal trauma.
• Holding ceremonies and rituals to acknowledge the rites of passage pertaining to parenthood and sexuality.
• Educate aspiring birth workers through apprenticeship, workshops, and other resources.
• Educate medical professionals and the population in general about their role and view on birth.
• Educate youth about sexuality and reproduction.
• Maintain physical and virtual spaces for spontaneous meetings and exchanges.
• Create birthing centers that are not tied to hospitals or regulated by medical policies

Bring birth back to the home

When birth is no longer pathologized, hospitals and doctors will be the alternative, not the norm. Giving birth at home will no longer feel dangerous when the savior mentality is not valid. This requires a certain level of sovereignty acquired through perinatal education, body literacy, sexuality and reproduction, conception and contraception. Women will be prepared to enter motherhood on a physical, emotional, psychological, neurological, and spiritual level, feeling confident about their bodies’ abilities to conceive, nurture and birth babies. 

Parents no longer need to let themselves be threatened, dismissed, bullied, gaslit and abused by the authorities who believe women’s bodies are defective. They no longer feel pressured to have a hospital birth for fear of being outcast of their communities. They know the benefits and risks involved with every option available, and will have made an informed decision about their choice.

Moving birth back to the home allows for the uniqueness of birth to unfold and more freedom of choice for the parents. The safe, private, undisturbed environment of the home provides the conditions for birth to evolve optimally, and a smooth transition for the baby. The midwife can enter this space without altering its nature when she is fully free to serve the parents’ choices and not be pressured to restrain her practice to what is legally permitted. She is free to use her  unique set of skills and wisdom, not rules and routine procedures. She is giving advice and asking for consent, not intervening prematurely.

Final Thoughts

I hope I have been able to demonstrate how common sense and beliefs about birth have been contributing to sustaining the monopoly of the medical industry over women’s bodies, choices and childbirth. It is paramount to realize how narratives have the power to shape culture, establish authority, build industries, and even influence the most basic aspects of human biology. If we continue to tell the same stories, we cannot move forward. By learning about what got us here, and the lies we have been told for so long that have become true, women can choose to write their own stories. 

Midwives and birth attendants hold a special position in this shift, since they are both witnessing and actively participating in women’s stories.When the State and authorities claim our private lives as a public matter, we lose freedom over our bodies, choices, and health. Women cannot let the system or the law define who or how they want to be served. When women are fully free to help each other, without fear of punishment or shaming, we will have reached another chapter in the story of birth. 

Lastly, I do not romanticize the role of the midwives, as they were also intervening in birth since before the advent of obstetrics. I also acknowledge and value the contributions of obstetrics and the many possibilities it made available. In fact, I challenge the fact that midwives and health practitioners are needed at all. Birth, life, and death are biological functions that happen whether or not we have the chance to control outcomes. In a truly sovereign society, we will be able to hold both the joy and the sorrow of the human experience without needing to blame or outsource responsibilities to anyone outside of ourselves.

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