Modern Midwifery vs Ancient Midwifery
In many hospitals, the line has been drawn; it’s all about the obstetrics vs midwifery, medical care vs midwifery-led care.
And then, there’s the relatively new debate within the scope of midwifery practice – that’s right; I’m talking about the far too common clash of midwives and doulas. In a way, this is modern midwifery vs ancient midwifery.
Doulas represent ancient midwifery, despite the fact that ten years ago the term ‘doula’ was foreign to most people – well, even more foreign, seeing as it actually comes from the ancient Greek word, doulos, which means slave. The early doulas were, in fact, slaves; wealthy women often had a trusted servant to care for them during pregnancy, birth, and then to help care for their babies. Later, ‘doula’ came to describe an older woman who had given birth herself and used her experience and intuition to comfort and support other women during birth. Today, a doula is ‘a woman experienced in childbirth who provides advice, information, emotional support, and physical comfort to a mother before, during, and just after childbirth’. ‘Doula’ has largely been replaced with the more politically correct ‘birth companion’ – although many doulas still slave away with very little, if any, remuneration.
It seems like doulas and midwives have common goals and should be able to work well together – so where does the clash come in? May I be bold enough to suggest that there might be a bit of guilt involved?
In most countries, hospital midwifery simply pays lip service to the softer side of midwifery: the emotional care and silent, watchful, comforting, oxytocin-supportive presence of being ‘with woman’ – the literal meaning of ‘midwife’. Many hospitals, midwives and obstetricians have bought into the idea that medical midwifery is superior, and midwives have relinquished their ‘with woman’ roles. Is there perhaps a bit of resentment over the fact that doulas are still fulfilling the role that has always been at the heart of midwifery: protecting the mother from counterproductive stimuli, providing a reassuring presence, being sensitive to any signs of risk, believing in a woman’s ability to birth naturally, and assisting the mother when needed?
Midwives’ knowledge and experience are still absolutely essential to birth. However, with many hospitals insisting that staff shortages and institutional protocols mean that there is less time for ‘old-fashioned’ midwifery care, isn’t it a relief to know that doulas can step in so that moms still get this much needed support? With the current perinatal mortality and the importance of physiological labour, our focus should be on what’s best for mothers and infants: everyone deserves to not just survive birth, but to have a positive birth experience. It seems that this can be best achieved by combining doula and midwifery skills – there are times when ancient and postmodern midwifery can and should meet. I call this post-modern midwifery!