Definitions & Fundamental Principles:
Midwifery ~ noun mid·wif·ery (mĭd-wĭf’ə-rē) {mid-whiff-ery}
“The techniques and practice of midwifery including childbirth assistance, the independent care of essentially normal healthy women and infants before, during, and after childbirth and, in collaboration with medical personnel, the consultation, management, and referral of cases in which abnormalities develop.”
The American Heritage® Stedman’s Medical Dictionary; Copyright © 2002, 2001, 1995 Houghton Mifflin Company. Published by Houghton Mifflin Co.
Definition of the Midwife ~ adapted from ICM to conform with the California Licensed Midwifery Practice Act of 1993:
The midwife is recognized as a responsible and accountable professional who works in partnership with childbearing women to provide the necessary support, care and advice during pregnancy, labor and the postpartum period, to conduct births on the midwife’s own responsibility and provide care for the newborn infant.
In addition, the professional midwife provides health counseling and education for childbearing women, family members and the community relative to pregnancy, childbirth, breastfeeding, and preparation for parenthood. In some settings, this may extend to issues of general health, sexual or reproductive health, infant development and childcare.
The historic origins and modern practice of midwifery:
Midwifery is the world’s oldest independent healthcare discipline, with a history that traces back to 5,000 years to ancient Egypt. Historically, providers of midwifery supported childbearing women during the normal biological processes of pregnancy and childbirth by providing non-drug, non-surgical (i.e. non-allopathic) care and very basic (i.e. non-medical forms of emergency assistance).
The development of the modern biological sciences during the 19th and 20th century advanced the historic art of midwifery by combining its traditional hands-on support of normal childbearing with an additional source of knowledge based on the new discoveries in the biological sciences. The result was the modern profession of midwifery as a hybrid discipline that preserved and integrated the best of the traditional knowledge with newer and science-based methods and technologies.
Despite this modernization of midwifery, its historic and contemporary goals remain the same – safely meeting the physical, psychological and social needs of childbearing women and their newborn babies to the very best of the midwife’s ability.
Definition of “professional”
The word ‘professional’ derives from Latin verb “to profess”. Its linguistic lineage traces back to the Middle Ages, when ‘professional’ referred to the taking of final vows (usually at 5 year) by Roman Catholic nuns and monks. This occurred in a formal ceremony in front of the entire congregation, as a novitiate nun publicly ‘professed’ her commitment to abide by all the rules of behavior and ethical standards of her order. At that time, the novice nun’s white head covering was removed and replace by the traditional black head covering of her religious order. Thereafter she was referred to as a “professional”, i.e someone who had publicly professed her final vows of obedience to a written standard of behavior.
Later in the Middle Ages the word “professional” was applied to occupations operating under the exclusive license of the Crown that also abided by a public code of ethics. Members of each guild had to profess allegiance to the specific ethical precepts associated with their particular occupation. The OED defines the word ‘ethics’ as “moral principles that govern a person’s or group’s behavior”. Guilds with ethical codes were mainly from disciplines with lengthy academic requirements, such as medicine, law, theology and the early barber-surgeon guilds. Those who professed to the ethical standard of their guild were called ‘professionals’.
Today the idea of a ‘professional’ is associated with occupations that require advanced levels of education and in many cases requires its graduates to take and pass a certification or licensing exam, such as the state bar or state boards. Without these state-sanctions credentials, it would be illegal to provide the service in question. Until very recently (last 30-50 years) gender and racial bias restricted the access to professional education to upper class white males. These ‘white collar’ occupations were associated with increased social status and greater economic compensation. Fortunately, gender is no longer a barrier to a professional education.
The professional discipline of midwifery is founded on ethical principles
As a historic and modern discipline, midwifery was originally and continues to be structured to meet the broad continuum of needs experienced by essentially healthy childbearing women and their unborn and newborn babies. As a matter of functional necessity, midwives organized around their efforts around the specific biological, physiological, psychological, emotional, cultural, societal and inter-generational needs of a healthy childbearing population.
As a practical discipline, midwifery reflects the short, medium and long-range values of society for the preservation of life, prevention of unnecessary suffering and reduction or elimination of permanent disability of either mother or baby. In meeting these immutable needs, the discipline of midwifery must systematically provide society with care that is safe, cost-effective, accessible and culturally-acceptability to its target population of childbearing families. In the modern world, this goal naturally requires a reciprocal relationship with physicians and other medical providers and appropriate access to and use of the healthcare system as the need arises.
As a discipline, midwifery has an inherent integrity that cannot be casually deconstructed by policies that reflect the preference or prejudice of any special interest group, including midwives themselves or professions that are in economic competition with midwifery. It is inevitable that policies constructed under these circumstance will ultimately distort or deform the basic nature of midwifery practice, potentially destroying the ability of its practitioners to adequately and appropriately meet the needs of childbearing families for safe and compassionate care.
In relation to the universal laws of aerodynamic it would be instantly obvious that form must always follow function. For example, the aviation must always remain true to the laws of aerodynamic and cannot function under policies that violate those principles, such as a policy that indiscriminately mandated a shorter wing span or prevented certain types of pilots from regularly refueling their aircraft. This ill-advised state of affairs would be quickly corrected.
The same principles of integrity — form must reflect the ability to function safely — applies to the discipline of midwifery. The legislative purpose of professional licensing is to increase consumer safety; if licensing requirements instead drastically reduce access to care and/or increase the likelihood of death or disability (for example, by prohibiting the midwife from providing care), then such provisions are counter-productive. Love never kills to save.
For both practical and ethical reasons, the profession of midwifery must not be allowed to be politicalized under circumstances that generate unnecessary risks and burdens to its practitioners that in turn force practicing midwives to transfer these unnatural risks and/or burdens to the childbirth woman or her unborn/newborn baby. If ill-advised policies of this type occur, they should be corrected as quickly as possible.
Identifying the ethical basis for the professional practice of midwifery
Ethical standards for the practice of midwifery are based on the principles of competent care in the context of midwifery as a modern healthcare discipline. This is consistent with the historical practice and modern professional training of midwives, as well as the social objectives of midwifery, which is to render safe and professional care to healthy women and their infants with full respect for human life and human dignity. Each client is independently important.
Each midwife should uphold the dignity and honor of the profession and accept its self-imposed disciplines. This includes a responsibility to uphold professional practice standards, provide evidence-based care and avoid compromise based on personal or institutional expediency.
Professional midwives should merit the confidence of women entrusted to their care, rendering to each a full measure of service and devotion.