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Midwifery Reborn: Politicians Take Note

by Lesley Cohen

Healthcare remains a forefront issue for the American public. With a new president who acknowledges the need for healthcare reform, midwives are in an optimal position to assert their importance as principal members of America's primary care providers.

As a member of this midwifery profession, I have the honor and privilege of providing care to women, guiding them and assisting them in their family planning, gynecological and primary health. At its core, midwifery embraces the spirit of feminism. Midwifery means literally "with women." Translated into practice, midwifery is a profession dedicated to providing women with comprehensive care throughout their lifetimes.

Midwifery has existed throughout human history: midwives are even referenced in the Book of Genesis. Despite this, the acceptance and use of these professionals in the United States has oscillated with sometimes tenuous relationships between the governing bodies, the American College of Obstetrics & Gynecology and the American College of Nurse Midwives. In colonial times, midwives were the primary birth attendants in the U.S., but by the mid 1800s, midwives were ostracized and obstetric care moved into hospitals. Yet, midwifery has passionately endured and in the 1970s, midwives were embraced by women choosing "alternative" healthcare practices.

Presently, midwives are professionals in all healthcare settings: hospitals, clinics, private practices, birth centers. Over 7,000 certified nurse-midwives (CNM) practice in all 50 states and many developing countries. In 2005, certified nurse-midwives attended almost eight percent of all U.S. births, according to the American College of Nurse Midwives (ACNM).

Why do women choose a midwife? My first thought is that midwives provide great care, of course. Midwives are committed to health promotion, disease prevention, continuity of care and patient empowerment. But the real answer is more complex. For some women, choosing a midwife is an active decision, but for others, midwives fill gaps in the healthcare system.

Women who choose a midwife seek comprehensive, women-centered care for their gynecological, obstetrical, and primary care needs. Midwives are known to provide a holistic, non-interventional approach to healthcare and many women elect an out-of-hospital birth with care by a midwife or desire a health promotional style.

In contrast, other women may find themselves inadvertently cared for by midwives. In rural communities where shortages of healthcare practitioners often exist, some women lack choice of a provider. These women may or may not know initially that their practitioner is a midwife: the provider simply may be a convenient, available person. In urban communities, where a multitude of healthcare practitioners exist, women may also unknowingly receive midwifery care. In such instances, midwives may be part of the healthcare team from which a woman knows she is receiving quality care, although she may be oblivious to the profession of her practitioner. Seemingly, a pervasive ignorance exists that there are various types of primary healthcare professionals. Through providing quality care and treating her with respect, a midwife often enlightens these women to the benefits of the "alternate" care provider.

Throughout my professional tenure, I have served both women who had actively sought out a midwife and those who were uninformed of my qualifications. Women come to me from diverse backgrounds, educational levels and varied socioeconomic statuses. Midwives regularly transcend these differences by providing safe, comprehensive care.

As a certified nurse-midwife, I honor each woman while educating her to the ideals and practice of midwifery. Midwifery has important values that should also be honored as we enter a new era of healthcare consciousness.

February 26, 2009

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Lesley Cohen, CNM, MSN, MPH, is certified nurse-midwife at Choices Women's Medical Center in Long Island City, New York. As a Columbia University trained midwife, she has worked in private practice, hospital, birth center, and clinic settings and is committed to improving the health status of women through empowerment and providing quality care.

See Healthcare 'Reform' Is Not Enough by Susan Yanow in this edition of On The Issues Magazine.

Also see A Do-Over for Reproductive Justice by Gloria Feldt in the Café of this edition of On The Issues Magazine.


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