Traditional midwifery emphasizes the practice of holistic, minimal intervention, patient-centered, and community-based maternal and infant health care. In contrast, modern midwifery relies on contemporary medical protocols and medicine, occasionally aiming to preserve cultural heritage and traditional knowledge. Despite their differences, both practices share the same purpose of providing humanized and less invasive care for infants and mothers during the stages of pregnancy, labor, and postpartum. This essay aims to compare and contrast traditional and modern midwifery while examining the evolution of this ancient practice across different time periods.
Before the 20th century, midwifery did not necessitate formal training. According to Connerton (n.d.), midwifery is as old as childbearing. Midwives would gain extensive knowledge just by attending the births of family members, friends, and neighbors, relying on their experiences. They were often knowledgeable in various medical services beyond pregnancy, labor, and infant care, with this knowledge typically being acquired through experience and sometimes passed down through generations. However, they did not receive the title of midwife until they themselves had become mothers. From the beginning of the 18th century, male physicians worldwide began competing and collaborating with midwives. As they slowly developed, they began transforming the belief that the presence of men in the birthing room wasn’t offensive or improper. By the early 1990’s, the occupation started requiring licensing which led to middle and higher-class women preferring and promoting physician and hospital care because they had access to antisepsis and forceps.
In contrast to experienced and women-led traditional midwifery practice, modernized midwifery does require formal training and licensing. It is standardized and mainly medicine-based. An excerpt from Britannica states the two licensures for midwives, “Worldwide, there are two consistent approaches to licensed midwifery practice: one from nursing and the other from outside nursing- direct entry” Connerton (2024). Nurse midwives (CNM) must get a nursing degree and become nurse practitioners to then add midwifery training and receive certification or mastery. Direct-entry midwives receive formal midwifery training based on proven practices and professional certifications from the North American Registry of Midwives or the American Midwifery Certification Board as CPM-certified professional midwives or CM, certified midwives which allows them to attend all types of births in homes, centers, and hospital settings just as CNM’s.
Traditional and modernized midwifery share the common goal of assisting women in childbirth while ensuring the safety and health of both the mother and the baby. However, modern hospital births and hospital or nurse-midwifery have a different approach. Traditional midwifery emphasizes hands-on yet minimal intervention and natural remedies, which most modernized midwives at birth centers and home births also practice. Minimal intervention means giving women the option to choose what they believe is best for them throughout their pregnancy and labor. Women throughout their pregnancy have the right to deny any laboratories, medication, procedures, and injections they may not want to receive.
In traditional midwifery and most modernized midwives there’s the belief women have the freedom to give birth in the position and place that they feel is best for them. “Moving around in labor and trying out a variety of birth positions to find the most suitable one allows women to jump-start stalled labor, to mitigate the pain of labor and delivery, and to give birth without the aid of pain relief.” (Mudler, 2024). On the other hand, modernized nurse midwives practicing hospital births often involve the laboring woman being strapped to a hospital bed, the use or forceps, and inducing or numbing labor with the use of harsh medications that can result in the child being born depressed. However, this setup is more for the convenience of the physician than the woman and is not optimal for labor, negating the benefits of gravity for the baby. Although these tools can save the life of a mother or baby, it’s mainly used to fasten the process of birth for the physician rather than honoring the timing of the mother's body and process of birth which is different for every woman. "In most countries, hospital midwifery merely gives lip service to the emotional care and supportive presence of being 'with woman' – the literal meaning of 'midwife'" (Mudler, 2016). Modern midwives who practice in a hospital setting are not bound by these guidelines. Successful labor can occur at home, in any comfortable location for the woman, using tools such as a Doppler to monitor the baby's heart rate, a blood pressure machine, thermometer, stethoscopes, and the use of complementary and alternative therapies, over-the-counter medication.
Midwife training by Health Sector. Drawing used in OMIECH community workshop. Source: Antonio Vazquez, 2020.
Traditional midwifery emphasizes community-based care, is patient-centered, and adjusts to cultural practices. It is focused on the patient and her family, a relationship is formed with the patient for the midwives to better assist and accommodate their needs as well as their families during the pregnancy, labor, and postpartum period. In contrast, modernized hospitals or nurse midwives are evidence-based and follow standardized health care protocols, they aren’t patient-centered due to the demand for health care assistance at hospitals. “Many hospitals insisting that staff shortages and institutional protocols mean that there is less time for ‘old-fashioned’ midwifery care” (Sensitive Midwifery, n.d.).
A traditional midwife provides the patient with the education and information needed for the patient to make better-suited decisions. Modernized midwives who attend birth at home or birth centers also practice this way. They refer the patients to better-suited physicians for any laboratory work needed, procedures, and even mental health care. This shows the concept of community-based care in traditional midwifery that is also followed in modern midwifery.
In conclusion, both traditional and modern midwifery play crucial roles in maternal and infant health care. Each with its unique strengths and different approaches. Traditional midwifery, through its holistic, patient-centered, community-based care and minimal intervention, emphasizes the preservation of cultural practices. It creates strong relationships between midwives and families, which personalize the care through pregnancy, labor, and postpartum. Modern midwifery through contemporary medical protocols, formal training, and evidence-based practices also continues with its essence of traditional care, despite the challenges that institutional protocols, the demand for healthcare services, and the shortage of staff pose for midwives in a hospital-like practice. Modern midwives continue to advocate for less invasive care, especially in non-hospital settings, and patient autonomy.
Ultimately, the evolution of midwifery reflects both ancient wisdom and modern science, aiming to provide safe, respectful, and individualized care for infants and mothers. By understanding and appreciating the contributions of both traditional and modern midwifery, we can create a more inclusive and effective maternal and infant healthcare system that honors the diverse needs and preferences of women and their families but as Mudler (2016) said, "There is something important to be learned from the traditional practice of midwifery, particularly in its modern iteration. Sometimes the “great” advances of modern medicine do not have the intended effect and are rooted not in data, but in patriarchy.”
This blog post was written by Alanis J. Flores Rosado, drawing from reliable and academic resources as part of her academic journey as a student midwife.
References:
Connerton, W. C. (n.d.). Midwifery. Encyclopaedia Britannica; Encyclopaedia Britannica.
https://www.britannica.com/science/midwifery
Modern Midwifery vs Ancient Midwifery – Sensitive Midwifery. (n.d.). Sensitive Midwifery.
https://sensitivemidwifery.co.za/2019/08/19/modern-midwifery-vs-ancient-midwifery/
Mulder, T. (2016, December 16). Midwifery, Then and Now. This article is part of a five-part… |
by Tara Mulder | EIDOLON. Medium; EIDOLON. https://eidolon.pub/midwifery-then-and-now-7c3447b84675
Weaver, L. (2024, February 14). Modern Midwifery: Blending Tradition With Evidence-Based
Care. Labors of Love Birth Center Serving Spartanburg & Greenville; Labors of Love Birth Center. https://laborsoflovebirthcenter.com/modern-midwifery-blending-tradition-with-evidence-based-care/
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