Is the Community Midwife Dead?

September 4, 2016

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communitymidwifephotoIs the community midwife a unicorn? I’ve been wondering if, because of politics and rules and regs (amongst the reasons), this community figure has become more myth and a thing of the past. I’m definitely sad if this is the case, and for many reasons I mourn her.

Maybe it’s not like this where you live, but where I am…community midwifery seems dead. There isn’t one person (not even me) serving everyone in the community ; I’m more likely to be driving hours to mamas or even crossing the country for births, more often than serving someone right here. In my neighborhood. In 10 years, it’s happened only a handful of times that I have the luxury of walking to a birth!

And it’s not just the convenience. I wouldn’t say I mind the excess driving ( I also wouldn’t say I love it) but the convenience factor is of course less important than serving the right women. It’s also not as important as being available and accessible all the time, which again can be hard when traffic and cities stand between me and some of these mamas. But mostly, I mourn the community midwife for them, and for the way they can be served.

What are women missing when there isn’t a community midwife? So much. She’s missing someone close by, who can stop over with a few minutes notice. She’s missing someone who can come and go more easily (if needed) during her labor. What she’s REALLY missing is the midwife that can provide unbridled, true, home postpartum support. I actually love doing this for families, but the reality for me, too, is that I often just cannot do more than the minimum “care” when someone lives 3 hours away. With someone in the community, it’s so easy and joyful to serve and become part of the postpartum healing time. It’s so easy to pop over and brew some tea, or make a placenta smoothie, and leave. It’s easy to drop by and wash some dishes, and weigh the baby, and check in with the mom. It’s easy to do that full 7 days of postpartum care like Australian midwife Lisa Barrett taught me; it’s not only easy, it’s what’s truly needed in our culture.

New mamas need this “mythical” figure. In the absence of family and friends that understand the postpartum and often partners going back to work quickly, we need the community midwife for new mothers. And as much as I love (and use) phone and Skype to check in daily during this time, there is no substitute for seeing her face. For hearing her sincere words, and watching how she relates to her baby. The community midwife is there, to hold space and witness. Why do we think this ends with the birth?

I wish with my heart this archetype of the community midwife would resurface. Not just for me, although it’s definitely where my heart is. I wish it for the women, and my daughters, and generations to come. I want to see us leave behind the cold, clinical, “profession” of midwifery that makes women come to an office at 2 days postpartum. I want women in their communities to know that they need a midwife locally, and that it will probably enrich their lives and the lives of other community members.

New mothers need to feel special and pampered and honored. Without someone who has supported her close by, it changes things. The postpartum is such a tricky, emotional, overwhelming time for so many women. The last thing they need to feel like is a number, or just another appointment on the midwife’s schedule. But as midwives, we can usually only give them the true time and focus they deserve when we are intertwined with them in life.

Help bring back the community midwife by figuring out the options in your community. The midwives that have provided heart centered support in the past may now not be part of the political picture; this limits options for women and is making the community midwife extinct. Consider that, while fancy offices and clinics and centers LOOK really appealing, they rarely come with home visits and a midwife that will just as easily pick up a vacuum and throw in laundry as she will help you with breastfeeding. If you are learning midwifery, consider offering classes and gatherings to bring your community together. Be honored when the woman on your street wants to hire you as her midwife; and be honored when you get to serve her, bag in hand as you walk to her home.

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  1. Liz Moore says:

    Sadly, the biggest deterrent to community midwives here is MIDWIVES. Young, inexperienced women are travelling far and wide, undercutting other midwives’already low fees in order to build a practice. While the senior midwife I work with is happy to travel for breeches, twins, etc., she feels strongly about the role of the local, community midwife; aware of our families and there place in the world, much more than a paycheck.

  2. Maryn Green says:

    I agree. It’s hard, because sometimes I am the traveling midwife, not a part of that community. I always encourage and prefer women to hire midwives local to them, but I also understand when they don’t want the medicalized approach that is sometimes their only option.
    What do we do?

  3. Joy Horner says:

    I love this. It’s how I work as an independent midwife in the UK. Although most women dint know about independent midwives and those who do may think they cannot afford one. This means I too travel 1-2 hrs drive for those daily visits. Luckily my children have grown up and I have a campervan to cut down on some of the travelling time.
    Your article reminds me of tales from the 1950’s when my mentor Mary Cronk was a community midwife. This was the era of “call the midwife” Her clients knew where she lived as this was before most people had telephones in their homes. She rode her bike to her visits and knew if a new mother needed an extra visit that day as she would hang a fresh terry nappy out her bedroom window and Mary would see it as she went on her rounds.
    We need this heart centred care back in the heart of our communities. Thank you for reminding us of this. Xx

  4. Maryn Green says:

    That’s a sweet story, and one I wish we all could experience! I have heard similar stories of bike-riding midwives, only with a basket of supplies on their bicycle, and I yearn for simpler times. I guess we cqn’t change the era of cell phones and such, but it would be so beautiful to see women accessing this type of care in their lives. Love to you, Joy!!!

  5. Becky Banks says:

    My goal as a homebirth midwife is to serve a 30 min radius, so that I can do exactly what you described. The reality as a new midwife is that I have to be able to build a practice. I am in the US, and most people here go to the hospital nearest them, so we are working on rebuilding the expectation of birth at home,etc. as well. Eventually we hope to get back to what you describe.

  6. Maryn Green says:

    Right, and it IS about rebuilding and also waiting until people recognize the value of community…and the midwife….there is much work to be done, and it is not a simple issue!

  7. Danielle Bergum says:

    Yup, thought this for a long time. I believe it is a significant safety factor. A community midwife literally used to know the women. They lived within the communities with the families knowing how they ate, lived, and their relationship with those who would be present at the birth. Credentials have tried to replace what used to be known by the clients – and it doesn’t come close to what true knowledge and trust because of that first person knowledge creates. We are so far from what birth is or needs to be in our modern world…. IMHO. I’m not saying we can’t meet in the middle and serve our modern world – but our modern culture lacks so much.

  8. Radomi Meyer says:

    This is just exactly what I was getting at in my email to you. It has been really weighing on me to see and feel this shift away from true community midwifery. I too mourn for her and I hope that if enough women do as well she will revive and flourish! The postpartum is most definitely a place where so many women are sorely underserved and if for no other reason than that we have to keep the community midwife alive!

  9. Moksha says:

    May the community midwife be a reality soon.

  10. Andreina says:

    This is a beautiful reminder.. I still have hope I will someday be The (or one of the) community midwives of my community..

  11. Patricia says:

    YES! So far, in the community where I have served for 40 years, community midwifery has not been completely destroyed. For now, the state, that entity that presumes to tell women how, where & with whom they can give birth to their children, has left the door ajar for those of us who passionately honor family over regulation, to serve. Here, one can serve as a traditional midwife, providing care and support for ANY woman. “They” are closing in, and those who choose to be lorded over by the government by accepting the restrictions imposed by licensure for the benefit of third party payments are impassively accepting the suppression of birth rights. Birth centers vacuum up births in every community, leaving few families for us to serve, but, undaunted, we know that those families who are isolated and discriminated against in favor of restrictive rules and regulation will, at east for now, have passionate midwives to serve them. another issue we deal with in this state is a HUGE number of midwives. The local school produces many new midwives who remain in the big city, which sets up a situation of scarcity since the rates of homebirth remain pitifully low and that combined with the birth centers, run and staffed by licensed providers, create that scarcity for traditional midwives. We must address the issues of perception about BC birth and homebirth…..

  12. motherhero@yahoo.com says:

    Where I live there is a plethora of midwives, but good luck trying to find one who will attend “high risk” births (read: whatever the state deems too risky – including grand multipara, and women over 40!), not to mention those women who do not have insurance and cannot afford to pay. I have been attending births for over 20 years. I decided not to become licensed because a friend who was over 40 wanted to deliver at home, but could not find a licensed midwife willing to attend her. I was weeks from taking the NARM test. I assured her that I would not let her do this alone, and that was the deciding factor. I realized that there is a huge gap in midwifery care in this state, and the only way I can do it without getting into trouble (the state is fully aware of what I do!) is to NOT be licensed and that I do not charge a fee. I have gone to births several hours away, but of course I prefer to be closer to home. As long as the system prevents many women from having the birth they want, there need to be midwives willing to bridge that gap.

  13. Maryn Green says:

    Yes, exactly…that is my “issue” too. How can I be a community midwife, or how does that concept fit into the fact that we are some of the ONLY Midwives that will serve a woman? I totally agree and fill that gap. There is no perfect answer when rules and regs have determined what women a midwife can support, and when so many women are increasingly being labelled “high risk”. In any case, I agree with you. I love the women I support far away, but I relish those few and far between trips around the block too, and in general am mourning community. Thanks for your comment!

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We are mamas and midwives who decided to do birth differently– and bring others along with us. We are radical, fun to work with, and great at (lovingly) calling people on their bullshit to help move us all towards a new more beautiful world. With 12 children and over two decades of midwifery between us, we’ve learned a thing or two along the way, and Indie Birth is our space to share it all with you.

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