Today is International Midwives Day, and it’s doubly a big deal, as this year has also been chosen as the International Year of the Nurse and the Midwife by the World Health Organisation. I occupy a rather privileged place as I work both within an academic midwifery team as an obstetrician, and as an obstetrician providing clinical care alongside midwives. I want to write a note of appreciation for the midwives I know, and the ones I don’t, all around the world.
I have no doubt that more of what I know about obstetrics was taught to me by midwives than by obstetricians. I’m confident that this is probably true for most obstetricians. Midwives taught me how to listen to women and how to notice what they were doing with their bodies as they laboured. Midwives taught me to be patient, and that the baby (usually) comes if you wait long enough. And midwives taught me how to move really fast when things start to go pear shaped in a major way. I learned that when a midwife says “are you sure that’s what you want to do?”, they actually mean “that’s a really bad idea and you shouldn’t do that” – and they are typically right. And I learned that when a midwife says “I need you to come” that you just go and ask questions later, because they have a sixth sense for trouble that can sometimes be inhibited when they try to put it into words.
To all the midwives who have taught me, protected me, gathered me up, cheered me on, corrected me, challenged me, celebrated with me, commiserated with me, and walked beside me – I see you, I salute you, I value you.
For those of you reading this who are, or plan to be, obstetricians there are some things I’d like you to know about midwives.
I was taught some less than helpful views of midwives by obstetricians. You might have been exposed to these too. I picked up messages like “never trust midwives, always go check what they are telling you”, and that midwives’ knowledge is incomplete, not evidence based, and inferior to that of obstetricians. Despite experience of midwives as capable, trustworthy, knowledgeable clinicians, those messages get stuck in your brain. They generate a sort of cognitive dissonance between the obstetric world view of midwives as an inferior profession and our daily experience of working with midwives.
Teaching students who are learning to be, or are already, midwives has cured me of this cognitive dissonance. The students I have been privileged to teach are just as capable, clever, hard-working, and reliable as any medical students and doctors that I have taught. There are bits of knowledge that sit squarely in the midwifery box and not in the obstetric box, just as there are things that are clearly important things to know as an obstetrician but are not needed for midwives. My teaching takes place in the shared ground between our two professions. And it is in this space that I have been reminded again that midwives aren’t “less” than obstetricians, just different.
If you are an obstetrician, then here are some things I’d like you to learn about midwives. And if you already know these, I’d like to see proof that you are putting that knowledge into action.
• Midwives and midwifery are equivalent in stature, importance, authority, and relevance to obstetricians and obstetrics.
• Midwifery is a distinct knowledge paradigm with different values and philosophy to obstetrics. It is not a subset of obstetric knowledge. Nor is it wrong because it is different to the obstetric knowledge paradigm.
• Being able to learn from both midwifery and obstetric paradigms will make you a better obstetrician and a better human being.
• Midwives and the midwifery profession get a bum deal at pretty much every turn.
International Midwives’ Day in the International Year of the Nurse and the Midwife seems like a great time to not simply recognise that obstetricians benefit from good midwives and good midwifery practice. It is also a great time to (re)commit to removing structural barriers that prevent midwifery from being appropriately recognised as a distinct and valued profession and work to ensure that midwives are appropriately rewarded for the work the do.