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THE INDIVIDUALISTIC CULTURE OF MIDWIFERY

The Individualistic Culture of Midwifery Amanda Carlsen and Katherine Meinel Carroll University

THE INDIVIDUALISTIC CULTURE OF MIDWIFERY Introduction & Literature Review This paper will explore the verbal and nonverbal communication techniques and how midwives create a personal experience for an expectant mother and her family for a comfortable pregnancy and birth that reflects an individualistic culture. Midwives have been around since ancient times, long before hospitals even existed. Midwives are mentioned in The Bible in the Book of Genesis, 35:17: "And when she (Rachel) was in her hard labor, the midwife said to her, 'Fear not, for now you will have another son." The book of Exodus, 1:20 states, "Therefore God dealt well with the midwives: and the people multiplied, and waxed very mighty." In ancient and primitive societies, the midwife was seen as having great and mystical powers. Some praised them for their "powers" and others saw them as witches or having an alliance with the devil and were therefore killed and tortured. However, midwives still remained when it came to delivering babies. In 1900, midwives attended almost half of all births, but due to medicine during childbirth becoming more popular by 1935 that number had decreased to only 12.5%. During this time, midwives were seen as dirty and ignorant and women were being convinced that they would be safer in the hands of a doctor. By the 1960's, most babies were born in a hospital setting. Midwifery had faded and any babies born outside of the sterile environment of a hospital were labeled as contaminated and kept separately from the other babies. Midwifery started to arise again in the 1970s and 1980s with the emergence of the American College of Nurse-Midwives in 1968 making nurse-midwifery education standardized. During the 1970s, the number of out-of-hospital births almost doubled, but the overall number was still small. The Midwives' Alliance of North America was founded in 1982. This organization embraces all midwives, regardless of their training or credentials, but

THE INDIVIDUALISTIC CULTURE OF MIDWIFERY its focus became the expansion of practice rights for direct-entry midwives who attended homebirths. By the 1990s, the distinction between the groups of the American College of NurseMidwives and the Midwives' Alliance of North America became less distinct. By the late 1990s literature began to emerge with clinical research studies and scientific validation for the midwifery model care. More women were beginning to feel safe about homebirths. (Sullivan, N., 2002). The Netherlands conducts more deliveries by midwives than any other country in the world. In the Netherlands, one third of all babies are homebirths conducted by a midwife. What make the Netherlands different are the three levels of care provision: primary, secondary and tertiary care. General medical practitioners and independently practicing midwives are examples of primary care professionals (Amelink-Verburg, Rijnders, Buitendijk, 2009, p.923-932). Midwives are a big part of the primary healthcare system being that they can tell which women can have a homebirth and which women can deliver in "polyclinics", a short stay hospitals attended by midwives, and which women need to be referred to a specialist (Burcher, Mae-Wan Ho, 2001). In the US studies were done comparing the same amount of homebirths versus hospital births and it was found that the hospital births had six times higher fetal distress rates than homebirths. The study also showed hospital births were higher for maternal hemorrhages, limp and unresponsive newborns, permanent birth injuries caused by doctors, lacerations to mothers and infants, neonatal infections, forceps deliveries, cesarean sections, and episiotomies (Davenport, 2009). Research Question

THE INDIVIDUALISTIC CULTURE OF MIDWIFERY How do the different birthing techniques and emphasis on personalization reflect the individualistic culture of midwives and expecting mother? Methodology In order to better understand the homebirth mom culture we conducted a face-to-face interview with Coral, a doula at Well-Rounded Maternity Center in Menomonee Falls. Also to give us a better understanding we interviewed Jeni, a woman who has experienced two homebirths and an employee at Oconomowoc Memorial Hospital. Jeni described her personal experiences during the labor and delivery of both her children. She told us about her thoughts and feelings as she is an Obstetrician and Gynecology nurse but decided that homebirth was for her. Findings Through the communication of birthing techniques and personalization, midwives help expecting mothers have a comfortable pregnancy reflecting an individualistic culture. We interviewed Coral, a doula and the owner at Well-Rounded Maternity Center in Menomonee Falls, Wisconsin. Coral informed us that the only difference between a doula and a midwife is that a doula helps the woman through prenatal care and the delivery of the baby whereas a midwife is in charge of the safety and health of the mother and baby. A doula doesnt provide any medical care, which is the job for the midwife. From the moment we walked into Well-Rounded Maternity Center, it felt like we were walking into our grandmothers house. She greeted us with a smile and invited us to sit down in the waiting area. In the waiting area there were comfy couches and chairs, artwork and photographs on the walls of pregnant women and babies, and bookshelves filled with books

THE INDIVIDUALISTIC CULTURE OF MIDWIFERY published on homebirths/natural births, midwives, and pregnancy. Coral appeared to be the typical grandmotherly type, appearing to be in her late 50s and trying to make us as comfortable as possible offering us coffee and tea and soon as we got settled on the couch for the interview. She introduced herself as a doula and has hosted around 350 births at her birthing center in Menomonee Falls. She started by telling us the benefits of a natural birth vs. a hospital birth. According to Coral, 31% have Caesarean Section births due to being over-medicated. Having a natural, vaginal birth is much safer for mother and baby. Being medicated makes the woman immobile. During labor, mobility helps ease the pain. Its very important that the woman can change positions, said Coral. She also said, During prenatal care, midwives will have hour long visits with the mother focusing on what the mother wants. In a hospital setting, the doctors will have a six minute meeting with the mother and send her on her way. She went on to tell us how beneficial the longer meetings with the mother are, mainly because it gives the mother a chance to get to know who will be delivering her baby. Thats how the personalization and the trust are formed between midwife and mother. During these sessions the midwife really gets to focus on the wants and needs of the mother which enhances the comfort of the mother. She describes this personalization as being more satisfying. Coral compares the midwife to the husband during the pregnancy. Coral states, The husband and midwife have a few similarities during the pregnancy process. Often times the husband is in the room while the mother is delivering. He provides verbal encouragement for the woman and holds her hand through the pregnancy. The midwife does almost the same thing. She gives confidence between contractions and gives information during labor on what positions she should lie in and suggestions for breathing techniques . . . like a coach.

THE INDIVIDUALISTIC CULTURE OF MIDWIFERY Coral then goes on to describe the different birthing techniques that ease the labor for the woman. According to Coral, 1/3 to about of women having a natural birth delivers in water. Being in the water relieves stress and pain for the woman. She said that often there is soft, calming music playing and the woman is instructed to close her eyes and focus on the music. Other techniques that benefit the mother are massaging and counter-pressure exercises. Coral ended our visit by giving us a tour of her birthing center. It was just like walking in someones house. There was a small kitchen with a refrigerator and a microwave for lunchtime meals. Walking down the hallway there were two different rooms with furniture for the family to wait while the mother is in labor if they do not wish to be in the room. Well-Rounded Maternity Center only has one birthing room, which is enough because Coral said that there are usually only about 2 births per month at the Center. The birthing room looked like a typical bedroom minus the bed. There were photographs of previous births that took place in the room along with other photographs of pregnant women and babies. In the middle of the birthing room there was a big, blue, kiddies'-pool looking tub. Coral pointed out that the family of the mother would sit around the outside of the pool to comfort the mother. There was also a few chairs and couches in the room that the family of the mother could sit on. Coral provided us with pamphlets of information on natural births and midwives as we walked out the door and invited us to come back or email her if we had any more questions. We interviewed a woman names Jeni who works as an OB nurse at Prohealth Care Oconomowoc Memorial Hospital in Oconomowoc, WI. Jeni has had two at home births and was kind enough to share her experiences with us. Jeni started with telling us her pregnancies and births were very different from each other. With Jeni's first pregnancy her water broke while she

THE INDIVIDUALISTIC CULTURE OF MIDWIFERY was at a restaurant for dinner, this was a dear of her since it was her first pregnancy but many told her things like that never happen. Well it did and she said it was just as you see it on the movies it was a gush of fluids and there were contractions to follow. The second pregnancy her water broke in the early morning with a short amount of fluid running down her leg all day. She stated she wasn't even sure it was her water or if she had lost control of her bladder at that point. Jeni spent her second labor walking around the house cleaning and getting things ready for the birth of her second child. She stated that as the day went on contractions got closer and closer together till about 3pm when she decided to call her midwife and let her know the progress that she had been making. Jeni stated that as her midwife was pulling in the driveway she had a gush of fluids; she stated she wasn't sure if it was due to the relief of having someone with knowledge there now or if it was just a coincidence. When the midwife came inside and set up the things she had brought Jeni described the contractions as light and consistent, like her uterus was clamping down and releasing over and over again. Jeni stated that part of her pain tolerance was relaxing so they kept the lights dim to keep the mood calm. Jeni's pain techniques also included hypno-birthing which is a form of self hypnosis and she used that instead of pain medicine. Jeni stated that with both pregnancies she wasn't opposed to using pain medicine she just wanted to see how far she got into the labor and to see how much she could tolerate. She stated that the second time around she had gotten to the end of her rope and was ready to ask for pain medicine when her son was crowning. Jeni has requested using mineral oil to prevent any tearing which did work and she had no tearing. At 7:24 pm her son was born and Jeni stated she had never been more exhausted before. She said some of may have been since her second baby was bigger, or the fact that during her pregnancy she was running after her toddler son rather than napping when she needed to. Either way she said both her

THE INDIVIDUALISTIC CULTURE OF MIDWIFERY pregnancies were different and special and she is very glad she was able to deliver at home in her own environment. Being in control of her labor was very important to her and she was in total control with both. Conclusion The intent behind midwifery and doulas is to individualize the labor and delivery of the woman. Independence and self-reliance are what women strive for during the delivery of their child. The personal independence that a woman goes through during labor is where she finds her strength to persevere through contractions. During this intimate time this allows a woman to get in-touch with her inner strength and incorporate loved ones in the process. Through the verbal and nonverbal communication of a midwife, a laboring woman is able to control her birth using her thoughts, emotions, and behavior.

THE INDIVIDUALISTIC CULTURE OF MIDWIFERY References Amelink-Verburg, M.P., Rijnders, M.E.B., Buitendijk, S.E. (2009). A Trend analysis in referrals during pregnancy and labour in Dutch midwifery care 1988-2004. BJOG Journal of Obsterics and Gynaecology, 116:923-932. doi: 10.111/j.1471-0528.2009.02202.x Davenport, A. (2009, October) Who Benefits from Training Traditional Midwives? Retrieved November 13, 2010, from http://www.midwiferytoday.com/articles/whobenefits.asp Pewitt, A.T. (2008). The Experience of Perinatal Care at a Birthing Center: A Qualitative Pilot Study. The journal of Perinatal Education, 17(3), 42-50. doi:10.1624/105812408x329593 Sullivan, N. (2002, March 6). A short History of Midwifery. Retrieved November 10, 2010, from http://midwifeinfo.com/articles/a-short-history-of-midwifery Coral, personal communication, October 8, 2010 Jeni Paltiel, personal communication, November 8, 2010