Birth Models That Work

15. "Orchestrating Normal": The Conduct of Midwifery in the United States

415 Chapter 15 “Orchestrating Normal” The Conduct of Midwifery in the United States Holly Powell Kennedy Everybody whose life you touch, you have an opportunity to leave something positive or leave something negative...that’s why you just have to give, give her something. You know, a “take home”...her parting gift should be more than well, I had good care and...a good baby. You know—something for her head, something for her heart, something for her soul. Nurse-midwife (Kennedy, Davis, and Erickson-Owens 2006: 89) INTRODUCTION The focus of this book is to present what is working well for birth around the world, rather than what is not. The purpose of this chapter is to provide a lens with which to examine the midwifery model of care in the United States through a synthesis of my research program about the work of midwives and studies done by other U.S. colleagues. The model I describe is meant to stimulate reflection, research, and policy changes on the most effective and satisfying ways we can work “with women” during childbirth. It is essential for the reader of this chapter to understand my background and perspective, because it shapes and colors my research. I am a certified nurse-midwife/researcher who teaches midwives, advanced practice nurses, and doctoral students. In 1978, as a family nurse practitioner intern at the Frontier Nursing Service in the mountains of Kentucky, I stumbled onto the midwifery model of care. I was stunned—it was different from than anything I had seen before in nursing. Because of that pivotal experience, I became a midwife, and just celebrated my twenty-fourth anniversary of working with women and their families. Understanding my history is important because I came to childbirth afraid of it—until I went to midwifery school, I had never seen a birth without bright lights or technology . The environments in which I had observed birth all had the aura 416 h. p. kennedy of “critical” care. It took years to dispel those fears, and even today, vestigial memories can creep in when I am tired. Throughout my years of practice, I have worked on local and national levels to support midwifery as a model that should be the standard of care for all women in the United States. During those years, some intensely political, I became increasingly aware that there were profound misconceptions and knowledge gaps among those I was trying to convince. The first was the lack of studies to link the actual work (or processes of care) of midwives with perinatal and women’s health outcomes. We knew that midwifery outcomes were excellent compared with medicine (Harvey et al. 1996; MacDorman and Singh, 1998; Oakley et al. 1995), but we had not identified or described the reasons for this very well. The second gap was why midwives were not particularly esteemed or sought after in many communities . To this day I receive comments from people who, upon learning my occupation, say “I didn’t think that was legal.” These two issues fueled my passion to create a research program dedicated to describing the work of midwives and linking it to outcomes. I think back to my early introduction to midwifery and realize that I did not understand fully what I saw—I just knew there was something special about the interaction between the midwife and each woman. But it was difficult to describe; it seemed almost invisible. That is what this chapter is about—describing the often invisible (and sometimes disparaged) work of midwives as a model of care that represents what all women deserve during the powerful and life-altering time in their lives that is pregnancy and birth. MIDWIFERY IN THE UNITED STATES The history of midwifery in the United States is rich, unique, and far too complex to fully describe in this chapter. However, a brief overview of midwifery’s past is essential to describe midwives’ current work within the culture of birth in the United States. We reflect those roots in our actions, our writings, and our day-to-day work with women giving birth and across their lifespan. Little is known about the work of indigenous midwives prior to the colonization of North America (Bushnell 1981). Early midwives came to the United States as immigrants or slaves and cared for women from their own communities during the first 250 years of settlement (Rooks 1997). Each future midwife was usually an informal apprentice...