What is a midwife? There's more to the story than catching babies.
I could give you a textbook definition of what a midwife is, but you can find that anywhere with a quick Google search. I could tell you all about the Midwives Model of Care and spout statistics about how great midwifery care is. I'm not going to do that here. I could tell you how skilled we are and how we are the experts in out-of-hospital birth. Not today. Instead, I'm, going to share the rest of what being a midwife means to me, personally, as an independent midwife.
We Give All We've Got
A midwife is, by her nature, a giver. We give our time and energy, often at the expense of our health and our own family's needs. We're never really "off." For most of us, this means our phones are always on and within easy reach (even when we're in the shower), and when someone else has the same ringtone, we have a little feeling of panic when their phone rings. Our car's trunk is full of our birth bags instead of our kids' soccer gear. Our gas tank is never empty and our bags always have a Larabar or some other snack food. We pay more attention to the weather than a 6th grader desperately hoping for a snow day. Snow makes us a little nervous. Same with full moons.
When we go out to dinner with our families, we take 2 cars. We plan our vacations 9 months in advance. Every midwife has had to cancel family plans at the last minute, missed Christmas morning because of being at a birth, or had to leave a sick child to attend to another family's needs.
We Think 10 Steps Ahead
We're planners, even if we seem to be flying by the seat of our yoga pants. Being the room mom, Girl/Boy Scout leader, Sunday school teacher, or soccer coach are really challenging for us due to our unpredictable schedules, so we're often the last to volunteer. When we do volunteer, we're likely the one who always brings plates and cups to the school events. We're always thinking about what's next and the "what ifs" of our lives and of our clients who may need us. We make holiday meals in advance and leave instructions with our partners and children for what to do if we aren't there to pull it all together. We vote by absentee ballot. We plan haircuts for days when we think we're least likely to be called to a birth. We carefully consider the cancellation policy for our own chiropractors, doctors, dentists, photographers, and the events we attend. Our answer, when asked if we can attend something is usually, "yes, as long as I'm not at a birth."
We think about traffic and the best path to our client's house before we leave our own house to run errands for the day. Childcare arrangements are always in place, especially for those middle of the night dashes out the door with no prior notice. We have a backup plan for ourselves and our birth assistants in case there are two births at once. We make sure we have extra batteries in our bag for our Dopplers. We make sure our meds are not expired. We keep a change of clothes and shoes in our cars in case of an unexpected drenching by amniotic fluid or birth pool water. While you're pushing out your baby, we're making sure we have scoped out the best path from the birth pool to the bed, know where the emergency supplies are, and we know where your birth photographer can get that once-in-a-lifetime shot.
We're Political Activists
We constantly fight to defend our right to exist. The struggle never ends. Our profession is not entirely understood by the medical community or legislators. As midwives, we do not practice obstetrics. We do not practice medicine. We see pregnancy and birth as normal physiologic functions for healthy women, so our focus is on maintaining health, rather than curing disease. Hospital-based providers see all of the scary, life-threatening problems we don't normally see. We see the hospital providers only when we need them, after we've exhausted all of our other options, so they never have the privilege we have of seeing normal physiologic births and having that be their point of reference.
As autonomous care providers, we don't fit into the hierarchy of the hospital, which is really difficult for hospital-based providers to understand. People often don't understand why families would choose to give birth outside of the hospital. Midwives spend a lot of time informing the public, informing the hospital-based providers, and informing legislators about why people would choose to do things differently.
We spend a lot of time defending our education and increasing our credibility. We are educated differently. Our education is in midwifery, not in medicine, and that's hard for mainstream society to understand. We come into the profession through a variety of pathways. Some CPMs have a formal education in an accredited school, while others are more self-directed, but we all pass the same test, and we all are required to have the same clinical experience. In a society that values formal education, it's hard for people to understand how we have excellent outcomes without requiring medical school or without having a Master's degree.
We are small in numbers, but we are a loud voice. Many of us volunteer considerable time working at the state and national level to advocate for the profession. We lobby Congress, we participate in advisory boards, and we are ever vigilant in watching for new legislation that may limit our practice or our clients' autonomy.
When you have a midwife, you have an advocate. We spend so many hours with our clients, getting to know them and their needs. We develop relationships with their other children, their partner, and their parents. This relationship with you and your family is probably the most satisfying thing about being your midwife. We love including your family in your care, letting your little ones "help" take your blood pressure, showing your partner how to feel your baby's position, answering your mother's concerns about her child's choice to give birth outside the hospital.
We think about you between visits. We pray for you and your baby. We love it when you remember us with a Christmas card or a birthday picture. We miss you between babies, jump for joy when you text us with a picture of a positive pregnancy test, cry with you through your miscarriage, and miss you if you move away.
We are so emotionally invested in you and your baby that we feel compelled to go to bat for you. When you make choices that are in contradiction to what the medical community would recommend, we stand up for your right to make your own informed decisions. We create a bubble of support around you if we go to the hospital, guarding your birth plan as much as possible. We stay with you at the hospital (sometimes for days) so we can maintain that support and continuity of care for you.
We're Business Owners
As independent midwives, not hospital employees, we are small business owners. We do bookkeeping, financial planning, and marketing for our practices. Some of us have employees helping us, which adds another layer of complexity. We maintain compliance with employment laws, CLIA, OSHA, and HIPAA.
For those of us who bill insurance, that's a whole other struggle. The insurance companies' goal seems to be to not pay, so we have to fight for every bit of insurance reimbursement we get. The rules/requirements vary from company to company, and each individual insurance plan has differences. When we do get paid, it seems like the amount we get paid just keeps going down. Claims get rejected and need to be resubmitted. Exceptions and appeals are negotiated, and it can take more than a year to get paid sometimes.
We can have significant variability in our income from month to month. One month, we may have only 1 birth, while the next, we may have 5 or 6. This makes it pretty challenging to get our bills paid and to keep talented people on staff. During the slow months, we still have bills to pay, and if just one person is late paying their fees to us, it can have a significant ripple effect on the people who work for us. Nobody wants to pay their midwife during December, but their midwife still needs to pay for Christmas presents she may never see her kids open because she's been called to a birth.
We're Lifelong Learners and Educators
We're constantly learning new things from the families we serve. Every birth teaches us something. We keep our eyes open for new studies and new continuing education opportunities. We do drills on emergency procedures. We meet for community peer review so we can help other midwives in the community and learn from their experiences. Our thirst for knowledge is unquenchable.
Most of us give our time to teaching the next generation of midwives. We're generally not paid for that work, but we know how important it is that our profession continue into the future. We take new aspiring midwives under our wings and help them try on the profession to see if it works for them. We pass midwifery knowledge from one generation to the next, so your daughters and granddaughters will be able to have a midwife to help them with their babies.
We're Engineers and Innovators
MacGyver had nothing on us. Midwives are the experts in making do with very little. We breathe life into a baby without a NICU team. A coat hanger on a curtain rod makes a great IV pole. A heating pad in a pillow case keeps the baby blankets warm. A knotted sheet thrown over a door works great as a rope for the mom to pull on as she squats to push her baby out. Plastic trash bags protect pillows from body fluids. We can use two chairs and a stack of books to get a mom into a good position for suturing. Electricity goes out? We've got flashlights. We can syphon a birth pool without a pump. With a little hydrogen peroxide and some cold water, we can get blood out of everything. When a mother is hungry and has very little food in the house, we can make soup out of anything.
Midwifery is NOT obstetrics. We're process oriented, rather than product oriented. We know that giving birth is a unique and personal experience for every person, so we honor that at every step of the way.
I like to think about the difference between a custom-made heirloom quilt made by a seamstress and a machine-made quilt you can find in the department store. They both keep you warm, they both cover the bed and look nice, but there's a lot of love that goes into that handmade quilt. Hours of careful attention to every detail. Time spent making decisions about the design of the quilt, choosing just the right fabrics, carefully cutting and sewing a masterpiece can't be replicated by a machine in a factory. Some factory-made quilts can be very special and be made of fine fabrics, but the humanity that resides in a quilt finished by an artisan is something you just can't replicate with a machine.
This is the work of the midwife. We are the artisans of birth. It's your birth and your baby, but we specialize in putting the humanity back into the process. We have reverence for the beauty of your journey and we rejoice in your empowerment, while simultaneously being watchful and quietly guarding your safety.
We midwives occupy a unique space in the human experience. We're adaptable keepers of birth, guardians of autonomy, and passionate advocates. We're some of the toughest, smartest, most resourceful people you'll ever meet. Mostly, we want you to be treated with respect and love as you bring new life into this world.