Chin Music Press - Adventures in Publishing - The war on midwives (part 2)

The war on midwives (part 2)

Life in Japan | Midwifery

My nonagenarian great aunt is a ball of fire. Toshi-oba (aunt Toshi) has strong and sensitive hands, a hearty laugh and an earthy demeanor. Nobody suspects that this four-foot-tall woman was the recipient of a cultural award from the late Emperor Showa for her outstanding work as a midwife in the rural community where she served.

Toshi-oba is retired now. But I bet in a pinch, like many a midwife who has come before and after her, she would rush to the side of a woman laboring at home.

A good thing too, that Toshi-oba lives in Japan. If she were to venture into a home to assist in a birth in the U.S. today, where midwives and the medical establishment are locked in a sort of obstetrical turf war, she would be walking into a legal minefield � regardless of the outcome of the birth.

From California to New York, midwives are being harrassed with lawsuits and legislation aimed at limiting their scope of activities or their right to practice, especially if they are not working within the parameters set by the medical community. Many have called the midwives' plight a "witch hunt" after the 17th century persecution of women believed to be witches. In fact, midwives were among those who were "charged" as witches and murdered.

The website Wears the Baby carries an interview with legendary U.S. midwife Ina May Gaskin:

�Some midwives have been charged with felons after births which turned out well. There is a California case in which a CNM (certified nurse midwife) was charged � taken from her home in handcuffs and chained to a wall for four hours � after a birth, a good outcome, that took place in her birth center when she was out of the country.�

Here in Seattle, certified nurse midwife Debra O'Conner, who specializes in out-of-hospital births, is appealing charges of negligence levied against her on the basis that her case was not judged by her peers. The case against her was initiated by a hospital midwife, which many out-of-hospital midwives argue is midwifery by name but basically medical profession by practice.

If there�s anything the two sides agree on, that is hospital births and out-of-hospital births in the U.S. are totally different. Even the hospital midwife, who brought the charges against O�Conner, agreed.

Japan is not necessarily much more enlightened, although midwives still carry a lot of social prestige. Personal experience tells me Japan has gotten increasingly closer to the Western medical model of childbirth through the postwar years.

When I told my obstetricians in Tokyo that I was planning a natural or water birth with a midwife, they both told me to be very careful. They were troubled by the absence of a physician in my birth plan.

The traditional practice of midwifery and the relatively new obstetrical model of maternity care are so starkly at odds with each other, two virtually separate standards of care have evolved over the years with very few points of intersection between them.

Midwives generally prefer less or no intervention, drugs and other artificial means to either accelerate or facilitate labor and delivery. Obstetricians, on the other hand, use whatever designated tools at their disposal in what they argue is a safer system for the child and mother.

So, whose model of care is better?

Study after study shows that birthing women attended by midwives have lower C-section rates, lower infant mortality rates, fewer episiotomies, and in general, experience fewer complications than they would under a physician-attended hospital birth.

Medical interventions are a necessity where they can preclude potentially life-threatening complications in high-risk pregnancies. But what many women don't seem to know is that medical intervention boosts the stakes wherever they fall in the risk spectrum.

Perhaps the question should be: Then why are the midwives being targeted?

Yuko >> February 08, 2005

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