I want to share some thoughts with you on midwifery legislation in our state.  Midwives are consistently supported by evidence to be the best providers for normal birth.  When I say this it does not mean that other providers are bad—quite the opposite.  Other providers have a place and are a very necessary piece of the modern birth puzzle.  Supporting midwives is not an effort to eliminate other providers.  

I believe that birth is a normal physiological function of a woman’s body.  I do not believe that pregnancy and birth are pathogenic (e.g. disease or illness).  Therefore, I do not believe that birth requires the practice of medicine.   Under this assumption I do not believe that midwifery is the practice of medicine.  Midwives support normal birth and I love them for it!  That being said, I also believe that we live in a society that largely does not agree with this, despite significant evidence to the contrary.

So what should we do when it comes to legislation?  Do I wish we could declare the practice of midwifery “not medicine” and decriminalize it?  Ultimately, yes.  That would give power to the consumer to make informed and educated decisions about their care provider(s).  However, where we stand currently there are no legislators in our state willing to support that.  That’s where we stand.  This leads me to lend my support to the licensing of Certified Professional Midwives (CPMs).

A little history lesson to elaborate on my stance:  One of the HUGE reasons we are in this “midwife mess” in the first place is because in the late 18th century men, with their new medical degrees out of Europe, started to attend births.  They called themselves man-midwives, because what else would you call a birth attendant!  The man-midwives (doctors) wanted to build their businesses, and one of the ways to do this, as we know all too well, is to eliminate the competition.  In this case, that meant eliminating midwives.  This was largely done through propaganda campaigns against midwives.  WE ARE HAVING THIS CONVERSATION TODAY BECAUSE THESE CAMPAIGNS WERE SO SUCCESSFUL!   One of the reasons the campaign against midwives is said to have been so successful is because the doctors grouped together.  They formed alliances and guilds and grew in number and power. This also improved their ability to communicate and present a unified front of the midwife “issue.”  For whatever reason, the midwives weren’t able to organize on a large scale and present a unified front.   Some writers have suggested that the midwives didn’t really see the doctors as a threat.  Perhaps they were thinking along the lines that I am, “birth is normal; therefore non-medical, and for all of history women (midwives) have attended other women in labor – we’re not worried.”  Let’s not underestimate the issue of power here.  Even in the areas where midwives did organize, at this time in history a group of women held little power when it comes to business, politics, and policymaking.

Let’s not make that mistake again. 

The history of birth in this country that tells me we need to unify around the issue and take action.  I’m unifying around the idea of increasing access to midwives.  I’ll always hold out hope that someday my education and change efforts will reach the tipping point and all will come to recognize that birth is normal.  Don’t get me wrong, I’m not giving up that fight – not at all.  Supporting midwives and the consumers who want to legal access them does not change the need to continue to educate and promote ongoing change.

Where we are right now: We are organized. We have the support on the legislative front.  And we have SCIENCE.  Yes, the evidence is also on the side of midwives. My belief is that licensing midwives in our state is a positive and necessary step for consumers of maternity care in our state and (in my opinion) for the midwives too.

One of the things that also happened in our collective birth history is that the man-midwives, who later declared themselves obstetricians, gained power over birth; previously it belonged exclusively to women. In doing so they also took it upon themselves to start naming and defining things.  The power to name and define is huge.

Imagine: for all history this thing that I am sitting on has been called a chair and has been sat on.  Then, rather suddenly, a group of people holding significant power come along and tell me that this is no longer to be called a chair and it is no longer for sitting.  If anyone wants to sit in it, there will be consequences.  If you want to use this chair properly, and without consequences, you must do so through us.  A few folks wanted to keep sitting in chairs so the group “allowed” this, but only under their regulation. 

The fact of the matter is that they have the power.  They are still able to name and define.  And until we enter into their realm and gain a seat at the power table we will continue to struggle. We have to play that game.  This legislation would mean a seat at the table, to be part of the naming and defining conversation.  It’s not ideal, but it’s better than being ignored and persecuted. It is a step in the right direction.  It is acknowledgement and recognition for midwives and their valuable role in society.  Someday I’d like to see the tables flip.  I’d love if the United States would figure out that the birth outcomes in countries where midwives are the primary birth attendant are not a fluke occurrence.  I’m going to continue to do the work I do to educate people under the belief that someday we’ll get there.  I feel confident in supporting this legislation because I believe it is a necessary means to keep moving us forward.

For more information about where midwives stand in Iowa and across the country check out The Big Push and Friends of Iowa Midwives.  

– Mandi Hardy Hillman, PhD, LPC, CD(DONA), ICCE

* When I contribute to this blog (or any blog) I always sign my name.  That means these are my thoughts.  Although, often they align with those of other IBO leaders and “fans,” they may not always.  

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