The Hallmarks of Midwifery part 2 - The Heart of Midwifery

The Heart of Midwifery

 

Hallmarks of Midwifery-The art and science of midwifery are characterized by the following hallmarks

 

O. Therapeutic value of human presence

 

Holding space.  It’s a buzzword lately. Everyone, in every walk of life, talks about holding space.  But what does it really mean?  You can find varying definitions online, from “bringing your entire presence to a person”, to “walking with a person without judgment or expectation”, to my personal favorite, “giving the energy of our attention to the pain and suffering of another human being.”

 

I had been a nurse for 14 years before I became a midwife, and an EMT for 4 years before that.  I had seen suffering, and pain, and death, and I had seen, and I hope lived, some beautiful examples of compassionate care.  But the day I really, truly understood what holding space could be was when I saw a midwife climb into bed with a grieving mother, curl around her gently, and hold her pain without imposing herself on it, while the mother quietly sobbed for her child.  This image is burned on my heart and my soul forever as an example of how to give, freely and purely, “your energy and attention to the pain and suffering of another human being.”

 

Midwives know how to hold space…I would say we define it…we refine it…and we usually ROCK it!!  The word midwife literally means, “with woman”. Not “at woman”, not “to woman”, not “for woman.” Just eloquently, and simply, “with woman.” We understand that sometimes, often, you do not need words, you do not need action, you just need us.  You need us there, quiet, present, solid and safe.

 

I would expand holding space though, beyond pain and suffering.  Midwives see clearly the need to hold space for so much…for quiet contemplation, for growth into parenthood, for undisturbed birth, for birth as you need it, for those magical moments when you first become parents and your whole world spins on its axis and realigns.  As midwives we understand that these are BIG moments.  HUGE moments.  Monumental, life changing moments.  And we know that these moments need space…to be observed, to be lived, to be felt deeply with every fiber of our being.  And we hold this space vigorously; guard it vehemently, usually with quiet grace and humility, occasionally with great power and force. 

 

Often space and time coincide, and all we need to do is grant you the respite of minutes, hours, or days of quiet.  Sometimes, space and time collide, and all we can give you is that second to kiss your baby before we have to resuscitate, that chance to squeeze your husband’s hand and lock eyes, and exchange a word of love, before we rush you back for an urgent c-section. 

 

Sometimes, systems support us, and we are encouraged and allowed to give you all the time and space you need for your thoughts, your decisions, your growth, your pain.  Often, systems subvert us, and it is everything we can do to eke out a moment of space for you and your family to grasp at. 

 

Know that we are trying.  Know that wherever we are practicing, however you perceive us, we care.  We see you.  We hear you.  We are trying, and will continue to try with every ounce of our being, to hold space for you.

 

In faith, love, and gratitude,
Julie

 

“Core competencies for basic midwifery practice.” American College of Nurse Midwives. Dec. 2012. http://www.midwife.org/ACNM/files/ACNMLibraryData/UPLOADFILENAME/000000000050/Core%20Comptencies%20Dec%202012.pdf

Accessed 4/29/2018

 

Kronen, Samuel.  “What it really means to hold space for someone.” Elephant Journal. May 18, 2017.  Waylon Lewis Enterprises. https://www.elephantjournal.com/2017/05/what-it-really-means-to-hold-space-for-someone/. Accessed April 29, 2018

 

 

 

 

The Hallmarks of Midwifery Part 1 - The Root Of Midwifery

The Root of Midwifery

 

American College of Nurse Midwives

Hallmarks of Midwifery- The art and science of midwifery are characterized by the following hallmarks

 

A. Recognition of menarche, pregnancy, birth, and menopause as normal physiologic and developmental processes

B. Advocacy of non-intervention in normal processes in the absence of complications

 

Every day I feel so blessed to have been introduced to the fact that birth is normal, and that we should not intervene unless complications present themselves, long before I began my midwifery training.  The hospital where I learned to trust birth was a bit unusual-we didn’t offer epidurals, only offered labor induction when medically necessary, and practiced the art of labor support beautifully.  The nurses and doctors who trained me were so skilled at this, I never knew it was out of the ordinary until I left. 

 

And then, when I became a midwife and left the hospital, the women at Alaska Family Health and Birth Center showed me how these ideas could be taken to a whole new level.  The midwives here live out the recognition of birth as normal, and advocacy of non-intervention in the absence of complications, to an extent I never even knew was possible.  Here I was taught to beautifully blend the art of watchful waiting with the evidence based and scientific skill of closely, meticulously watching for any potential complications. 

 

I never dreamed that a place that blended these two so well could exist.  A place where the midwives are encouraged and empowered to educate on normal throughout pregnancy, to offer reassurance and guidance to help couples navigate the mystery of pregnancy, birth, and parenting.  A place where midwives are taught to keep a watchful eye on pregnancy while reassuring normal, and to carefully and judiciously recommend testing and interventions when things deviate from the norm. A place where the midwives are charged with respecting and protecting the quiet, holy space of birth, while continually assessing the health of both mother and baby, and guarding these closely. 

 

I never dreamed there could be a place where one day we discuss the implications of prenatal parenting, and how the birth memories of the mother can repeat into her own birth story, and the next day we drill on neonatal resuscitation and birth emergencies until everyone present can perform the skills proficiently. A place where during chart review our counselor who specializes in perinatal mood disorders can guide us in providing trauma informed care to a woman with a history of sexual trauma, and the next minute we can discuss the skilled management of a postpartum hemorrhage with medications and emotional support seamlessly blended.

 

There are no words to adequately describe the sacred beauty of birth undisturbed.  If you have given birth with a midwife or provider who understands this, you may know it intimately. You may know the quiet of a room punctuated only by a mother’s soft moans as she rocks through the contraction.  You may know the complete reverence of parents who stare at the wide, blinking eyes of their newborn, uninterrupted by noise or staff intrusion.  But unless you have been a midwife in such a space you do not know that they are guarding this time, while also watching intently, ensuring that the baby is transitioning well, ensuring that bleeding is normal, and that both mother and baby remain healthy and stable. 

 

Non-intervention is reserved for when all is normal.  When things deviate from normal, a skilled, attentive midwife will have both the knowledge and the equipment to intervene and guard the health and well-being of the baby as much as they guarded the sacred rituals of birth.  These two things do not have to exist separately. 

 

I feel blessed to work in a place where we all believe in both the art and the science of midwifery.  Where we all believe in the glorious magic of undisturbed birth, but temper it with a healthy dose of reality, and the skills to manage complications when they arise.  Birth centers seem to be the best place to find a beautiful union of these two ideas, and I am so grateful I have found one to set down roots in.

 

In faith, love, and gratitude,

Julie

 

“Core competencies for basic midwifery practice.” American College of Nurse Midwives. Dec. 2012. http://www.midwife.org/ACNM/files/ACNMLibraryData/UPLOADFILENAME/000000000050/Core%20Comptencies%20Dec%202012.pdf

Accessed 4/29/2018

 

 

The Hallmarks of Midwifery - a series

This week I’d like to honor midwives all over the world with a
discussion of our amazing profession. May 5 is International Day of
the Midwife, and in celebration, I’d like to discuss a few of the
Hallmarks of Midwifery, as laid out by the American College of Nurse
Midwives. While this organization is not representative of all
midwives around the world, nor even in our practice at Alaska Family
Health and birth center, I believe the hallmarks summarize well the
core of most midwifery practice.
The Hallmarks of Midwifery-
The art and science of midwifery are characterized by the following
hallmarks:
A. Recognition of menarche, pregnancy, birth, and menopause as
normal physiologic and developmental processes
B.Advocacy of non-intervention in normal processes in the absence of
complications
C.Incorporation of scientific evidence into clinical practice
D.Promotion of woman-and family-centered care
E.Empowerment of women as partners in health care
F.Facilitation of healthy family and interpersonal relationships
G.Promotion of continuity of care
H.Health promotion, disease prevention, and health education
I.Promotion of a public health care perspective
J.Care to vulnerable populations
K.Advocacy for informed choice, shared decision making, and the right
to self- determination
L.Integration of cultural humility
M.Incorporation of evidence-based complementary and alternative
therapies in education and practice
N.Skillful communication, guidance, and counseling
O.Therapeutic value of human presence
P.Collaboration with other members of the interprofessional health care
team

“Core competencies for basic midwifery practice.” American College of Nurse Midwives. Dec. 2012. http://www.midwife.org/ACNM/files/ACNMLibraryData/UPLOADFILENAME/000000000050/Core%20Comptencies%20Dec%202012.pdf

Accessed 4/29/2018