Midwives: Who Are They and What Do They Do?

Midwives
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A midwife is a medical or health professional who caters for nursing and expectant mothers as well as newborn babies. They also specialize in childbirth or delivery, and their profession is known as midwifery.

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The training and schooling for a midwife are close in semblance to that of a nurse but very different from obstetricians and perinatologists who are referred to as doctors.

In a lot of countries, this profession is either an offshoot of nursing or is somewhat linked to nursing. Links between midwifery and nursing includes a mutual regulatory body.

However, they are regarded as distinctly separate professions or disciplines. Midwives are trained to be able to detect differences or exceptions from the usual progress of childbirth.

They tend to come in when it’s a high-risk event such as twin births, breech births and births where the baby is a posterior position, and employing the use of non-intrusive techniques when necessary.

When it comes to pregnancy-related complications that are beyond the scope of the midwife’s practice, the patients are referred to surgeons or doctors.

Such complications require the use of surgery and instruments to deliver the child. Midwifery works in concordance with care to pregnant women and nursing mothers.

A lot of developing countries are investing in the training of midwives. This includes a formal, professional training for people already functioning as traditional birth attendants.

Due to the shortage of funding, some essential care services are deficient. Why don’t you read on to find out more?

Definition and word origin of midwife

The International Confederation of Midwives defines a midwife as an individual who has fully completed an education course in midwifery that is recognized in the country it is situated.

It is based on the ICM Essential Competencies for Basic Midwifery Practice and the foundation for the ICM Global Standards for Midwifery Education.

A midwife is a professional who has attained the required qualifications to be licensed or legally registered to practice midwifery. It also extends to being qualified to use the title, “midwife” as well as the demonstration of efficiency in the practice of midwifery.

The term “midwife” is derived or sourced from old English “mid”, which means “with”, and “wif” which means “woman”. Midwife originally means “with woman”, which is a reference to the presence of a midwife beside the woman during labour.

Though midwifery is a profession heavily dominated by females, the meaning refers to both male and female midwives.

History of midwifery

In Ming China, a midwife compulsorily has to be a woman and must be familiar with the feminine body as well as the process of child delivery. The reason midwifery was sexually restricted was due to the presence of strict sex segmentation which was prevalent in the Ming dynasty.

Males were not permitted to see or have direct contact with a female’s body, and they played a very minor role during labour. They only took part in antenatal examinations and check-ups on the body after child delivery.

The skillset required for the practice or profession of midwifery was very different from medicine. This was because the bodies of pregnant women were not fully adjusted to a general medical approach.

Females who took an interest in the profession and wanted to be midwives themselves had to learn the skill from experts. This was the only way to learn then due to the absence of educational content on midwifery. Serving as a midwife in the Forbidden City was even more of a challenge.

Interested applicants were mandated to apply through the “Lodge of Ritual and Ceremony” which was also referred to as the “Bureau of Nursing Children”. This establishment was situated in the Forbidden City in the Central Borough.

It had several functions such as interviewing, training, hiring and making arrangements for female healers, which includes midwives who functioned in the palace.  After the selection of candidates, they were also mandated to register with the lodge to ensure working in the Forbidden City.

The responsibilities of a midwife did not end at child deliveries, and it also includes criminal investigations, particularly those that involved women. Crimes such as rape or determining the virginity of a woman because they were considered the top authority in sexual medicine.

Mass killings or death was prominently used as a tool of family planning in the Ming dynasty. Midwives and their knowledge regarding infanticide played vital roles in this.

After the birth of a child, the midwife assessed the baby and checks its gender. If the child was a female, the midwife asks the mother if she wants to keep the child or not. If the mother says no, the midwife kills the baby in a very stealthy and simple way and then asks the mother for her service fee.

Midwives were also regarded as “traders” of body parts which they furtively engaged in for extra income. They were responsible for waste disposal during the child delivery process and this included body parts from the placenta.

The nature of work of a midwife and the knowledge that comes with the job triggered a negative pubic disposition towards the midwives.

Midwives were looked down upon and were not considered experts simply because their skill set was not acquired from scholarly literature.  They regarded the existence of midwife as a necessary invention to fill in for the gender segmentation, which restricted the role of the male physician in childbearing.

Men practising midwifery

Men seldom enter the practice of midwifery for reasons that are both historical and cultural. In the early days of Greece, midwives were mandated by law to handle childbearing themselves, and this prevented the males from joining the profession.

During the 17th century in Europe, some male surgeons had a speciality in childbirth, especially deliveries requiring surgery or the use of surgical instruments. In the long run, this caused a division in expertise between the men and women. The men specialized in obstetrics while the women specialized in midwifery.

Men who are midwives are referred to as “midhusbands” based on a misperception on the etymology of “midwife”. They were also referred to as male midwives, and in past centuries, they were called “man-midwives”. William Smellie, who innovated the shape of forceps advised male midwives to adorn dresses. This, he said, was to reduce the controversy of a man being around during childbirth.

As the world progressed into modern civilization, men training to be midwives became pretty normal in most advanced countries. However, the presence of men in the midwifery profession is still very rare.

In the U.K, even after a ruling on sex discrimination was passed in 1975, the Royal College of Midwives prohibited men from the profession till 1983.

Fast forward to March 2016, U.K had between 113 and 137 registered male midwives, denoting 0.6% of all practising midwives in the U.K. In the U.S, there is a miniature but a consistent number of male midwives with training covering a full scope (CNMs/C.M.s).

They make up approximately 1% of the membership of the American College of Nurse-Midwives. In several cultures in Southeast Asia, a good number of the traditional midwives are men.

Midwifery’s scope of practice

A midwife is regarded as a health professional who operates in tandem with doctors and nurses to offer the needed support and aid during pregnancy, child delivery and the post-delivery period.

Their job description also includes monitoring and detecting of pregnancy-related complications in both the mother and her child.  Access to medical care for further assistance and the execution of emergency measures is also part of their responsibilities.

The midwife plays a vital role in the form of health counsel and education or sensitization, not just for the women, but also for the family and the immediate society. Their works also revolve around antenatal education and preparing potential parents for parenthood.

The scope of their practice extends to the health of the pregnancy as well as sexual health and child care practices. Midwives can practise their profession in a variety of settings such as clinics, homes, hospitals, community and health units.

Midwifery in various countries

Midwifery is a medical or health practice that cuts across different countries in the world. Some of these countries and how midwives are educated, trained and regulated as well as how they carry out their practice will be discussed below.

Midwifery in Australia

Midwifery academic programs at the undergraduate level last for three years for a full-time studentship, at the end of which the student is awarded a Bachelor of Midwifery.

This comes with a further 1-year full-time program, at the end of which the student is awarded a Bachelor of Midwifery (Honours).

There is also a postgraduate midwifery course, for which registered midwives enrol for, at the end of which they are awarded a Master in Midwifery, Master in Midwifery (research) and MSc Midwifery.

Postgraduate midwifery courses are also available for registered nurses who want to become midwives. At the end of these courses, they are awarded either a Bachelor’s degree in midwifery or an equivalent qualification such as a Graduate Diploma in midwifery.

In Australia, midwives must register with the Australian Health Practitioner Regulation Agency to practice as a midwife or use the title of a midwife or registered midwife.

Health organizations or services may employ midwives, or they could be self-employed and practice midwifery privately.

They are expected to practice within the boundaries of a defined scope and act following current regulatory criteria. This is done to ensure a safe and independent practice.

Professional body

  • Australian College of Midwives (ACM)

Midwifery in Canada

After a long period of intensive political lobbying carried out by consumers and midwives, midwifery became fully incorporated, regulated and publicly financed as a part of the health system.

This took place in British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Quebec, Nova Scotia, Nunavut and the Northwest territories. An undergraduate program for midwifery in Canada is a four-year duration for full-time students.

Completion of the program is awarded a Bachelor’s degree in midwifery: B.H.Sc. in Midwifery & Bachelor of Midwifery. Various parts of Canada have universities that offer midwifery as an academic program.

This includes areas such as Quebec, Manitoba, Alberta, British Columbia and Nunavut. Some of these areas even offer “bridging programs” for internationally trained midwives, particularly Ontario and British Columbia.

In Canada, midwives must be registered by the provincial regulatory bodies after evaluation and proper assessment. Midwifery is practised in a variety of ways; from the provision of continuity of care to nursing mothers and choice of place of child delivery. It also centres in the woman as the major decider in her maternity care.

Midwives consult with the appropriate medical authority when the nursing mothers or their babies are experiencing complications. They have access to proper tools of diagnosis such as ultrasounds and blood tests, and they are also able to prescribe a number of medications as well.

Midwives in Canada became an integral part of the health care mainstream when the practice of midwifery was legally recognized.

This recognition followed suit with rights to prescribe medications for pregnancy, birth and post-delivery, funding, hospital privileges. They also have the rights to access diagnostics and full access to medical consultation from specialists.

An unregulated midwife providing care with “restricted acts” in territories that are regulated is guilty of practising midwifery without a license.

This could subject them to investigation and prosecution. Before changes in legislation came along, just a small number of Canadian women had access to midwifery care because the health system financed it.

The legalization of midwifery in Canada made the services of midwifery obtainable to a broad and varied population of women. It also extends to societies where the present supply of midwives doesn’t match the demands for their services.

Their services are free of charge for women residing in provinces where the practice of midwifery is regulated.

Professional body

  • Canadian Association of Midwives (CAM)

Midwifery in France

The duration of the midwifery academic program for full-time undergraduates is five years. The first year is for medical studies, while the remaining four years is for the midwifery.

The program is completed with an award of a master’s degree in midwifery known as Diplôme d’Etat de Sage-Femme.

In France, midwives must register with the Ordre des sages-femmes before they can practise midwifery and use the title of sage-femme.

Professional bodies

  • L’Ordre des Sages-Femmes, Conseil National
  • Collège National des Sages-Femmes de France (CNSF)
  • Société Française de Maïeutique

Midwifery in the Netherlands

In the Netherlands, an undergraduate midwifery program lasts for four years and is awarded an HBO-bachelor Verloskunde on completion.

The Netherlands has four colleges of midwifery which include Amsterdam, Groningen, Rotterdam and Maastricht. Midwives are referred to as “vroedvrouw” (knowledge woman), “vroedmeester” (knowledge master or male) and verloskudige (deliverance experts) in Dutch.

Midwives are childbirth specialists whose practice are independent but affiliated with medical doctors and nurses.

Delivery of children at home is a usual practice in the Netherlands, but the rate at which this occurs has seen a steady decline for some years now.

The period between 2005 and 2008, 29% of newborns were delivered at home. This statistic declined to 23% between 2007 and 2010 and a further decline to 13.4% in 2014.

Midwifery is typically practised privately, although some practices are from the hospitals. The latter applies to outpatients in the hospital who usually give birth in the hospitals.

The midwife carries out the delivery in the delivery section of the hospital, usually without the assistance or intervention of the obstetrician.

The midwives only call for the assistance or intervention of the obstetrician when there is a complication with the child delivery. Besides child labour and post-delivery care, midwives are the first point of contact for expectant mothers.

They educate the expectant mothers on vital information about food, travel, lifestyle, habits, sex, alcohol, hobbies and so on.

Midwives are legally recognized to provide care and completely compensated by insurance firms in the Netherlands. Such care covers both prenatal care, child delivery and postnatal care for both the newborn and the nursing mother.

Professional body

  • Royal Dutch Organisation of Midwives | Koninklijke Nederlandse Organisatie van Verloskundigen (KNOV)

Midwifery in Mozambique

After the end of a civil war that lasted for 16 years, the health care system in Mozambique was severely affected, and 1 out of every 10 women died during child labour. For a country with an estimated population of 19 million then, only 18 were obstetricians in 1992.

Twenty-two years later, Mozambique heralded a new health care program to train midwives in emergency child care in order to ensure access to excellent medical care during pregnancy and labour.

These newly trained midwives were now capable of carrying out major surgical operations such as hysterectomy and cesarean section.

Mozambique had become one of the few countries on the right path to attain the millennium development goal of lowering the rate of maternal death by as much as 75% by 2015.

Midwifery in New Zealand

In New Zealand, midwifery is a regulated profession with no links or affiliation to nursing. It is a profession with a separate body of knowledge, an independent scope of practice, ethical codes and standards of practice.

The profession of midwifery in this country is held in high regard as it comes with knowledge, skills and capabilities to provide an essential and comprehensive maternity service to pregnant women on its own.

The undergraduate midwifery course lasts for three years on a full-time studentship. Each year has 3 trimesters, and at the end of the program, the students are awarded a Bachelor of Midwifery.

The postgraduate course for midwifery which registered midwives enrol for leads to postgraduate degrees of an equivalent qualification.

They include Postgraduate Certificate in Midwifery, Postgraduate Diploma in Midwifery, Master of Midwifery and PhD Professional Doctorate.

New Zealand has a compulsory national programme for all midwifery graduates known as the Midwifery First Year of Practice Programme (MFYP), regardless of the place of work.

The New Zealand College of Midwives is contracted by the financier, Health Workforce New Zealand to provide the programme under the programme specification.

Midwives in New Zealand must register with the Midwifery Council of New Zealand in order to practice midwifery, and use the title of midwife. An estimate of 78% opts for the job of a midwife.

Midwives provide care from a period ranging from the second trimester to 6 weeks after child delivery. Midwifery care is financed by the government in the case of government practice, while private child care attracts a fee.

Professional body

  • New Zealand College of Midwives

In conclusion, midwives are a vital part of the health care system. Despite the varying treatments and disposition towards them in some countries, they deserve more credit than they are given.

Sources;

  • Midwife – Wikipedia
Midwives
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Oluwafemi Michael
Oluwafemi Michael is an online Mental Health Therapist, Advocate for Mental Health Awareness, a programmer, and also a content creator from Edo state, Akoko-Edo LG.
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