Birthing Basics: Midwives

The Mama Sherpas clues us into the mysterious world of midwives.

Birthing Basics: Midwives

When filmmaker Brigid Maher’s hopes for a natural delivery with her first child were crushed after she ended up having a C-section, she was left with a hangover of guilt, anger and confusion. Her second pregnancy, three years later, offered the opportunity to try again for a natural birth via a vaginal birth after Caesarean (VBAC). She sought out the care of a nurse midwife, and after successfully delivering her daughter (who weighed in at 9 lbs, 10 oz), naturally, she was inspired to make a documentary to shed light on the world of midwifery.

Maher’s film, The Mama Sherpas, follows four midwifery practices around the country and shares the story of the midwives’ passion for the care of mothers and babies, and of mothers seeking to experience childbirth naturally in a hospital setting. With executive producers Ricki Lake and Abby Epstein on board, the film is a standout in the canon of films about birth and babies that many mothers seek out when they set out on the journey of pregnancy.

Susan Dejoy, a nurse midwife based in Springfield, Mass., is one of the practitioners featured in The Mama Sherpas. Her practice has delivered over 11,000 babies, and her passion for caring for women, during pregnancy as well as for routine wellness, is evident on screen. We were lucky enough to catch her between deliveries to chat about what midwifery is and why it should be a vital part of our country’s healthcare system instead of a left-of-center alternative.

Can you explain the technical difference between a midwife and an obstetrician?

A midwife is trained to handle normal, basically uncomplicated or minimally uncomplicated pregnancies, and focus on promoting normal physiology and birth experience. (Pregnancy) is an unusual area of healthcare in that our patients aren’t sick. We promote the natural process and the woman’s experience, education and her development as a new mom.

Physicians--god love them, we need them desperately! But they are focused on pathology and on treating disorders of pregnancy. And they do that very well—we need that in a well-rounded health system because not every pregnancy is normal. There’s an expression: when you’re a hammer, everything you see is a nail. Doctors tend to say that we midwives tend to not see the pathology, and we joke with our physician colleagues that they tend not to see the normal. The truth is we need a balance of both perspectives, working together. Midwives work in conjunction with physicians in most practices in the country, so that women can have seamless transitions of their care.

What is the greatest misconception about midwives?

I think the biggest misconception is that midwives don’t exist anymore. In other developed countries in the world, midwifery care is the model, it’s who you see if you’re healthy. Secondly, a big misconception is that midwives do home births only. That is a really, really small percentage of what happens in midwifery care. Only about 2% of those in nurse midwifery care are in practices that do home births.

What can you tell us about the difference between a midwife and a doctor during labor and delivery?

Midwives believe strongly in the normal physiologic labor and birth. We look at ourselves as guides to that process. It’s been described as ‘the art of doing nothing, well.' We watch and are vigilant, but we don’t intervene unless it’s necessary. We don’t routinely use IV’s, we support labor, as often as possible, without pain medication, and we try to support the normal processes as long as possible.

Midwives believe in the value of physical presence of the care provider in labor, and physicians tend to not be as present, they tend to pop in and out and let the nurses do the bedside care. They also tend to view some interventions as routine. For the birth itself, I think midwives tend to encourage a variety of positions and allow for pushing with the urge. Technique-wise, we tend to allow for birth to be slower, with less opportunity for tearing. Midwives cut less episiotomy, as a national statistic.

Culturally and medically, what do you see as the barriers to natural birth right now?

Right now we have a culture of intervention in childbirth. We feel that things need to be done to a woman for safety, and intervention has become normalized in our society.

The other cultural barrier is the opinion that pain is bad, and it is something to be avoided at all costs. In our country if you’re an athlete and you’re in pain, that’s considered a badge of honor—but for a woman in labor, it isn’t viewed that way. Women get afraid, and there’s this culture of fear around pregnancy, fear of pain, fear that they can’t do it. Hospital routines, from offering IV’s to the standard offer of epidural, get in the way. There’s not a lot of patience for things to unfold.

I don’t think we do enough to support the idea of birth as a normal, physiologic process. If I could wave my magic wand, I’d lower the lights in hospitals, and labor and delivery areas would be quieter. Staffing would be focused on minimal interactions with the woman in labor. I’d make sure that woman were educated and provided with information about normal labor prenatally, so they don’t come in cold. We’d ask about their preferences and respect them.

Why do practices across the country need to foster more collaboration between midwives and doctors, as they do in The Mama Sherpas?

The primary reason it’s important is for the woman herself. I would think it would be much more reassuring to be in a practice that could say, “No matter what develops during your pregnancy you can stay with us, and we have the right people who can see you no matter what comes up." It might mean you stay with a midwife for your whole pregnancy, or see a physician for a short time and then return to the midwives. It’s the right way to deliver care: to match the patient’s needs with the skillset of the person who can deliver it. It’s a waste of resources to have a doctor who has gone through four years of medical school, and completed their residency--who is essentially a surgeon--to manage normal, uncomplicated pregnancies.

Learn more about Susan and other midwives in The Mama Sherpas, now playing nationwide. You can also find it online here.

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