Reverberations
Kneelingwoman's post about midwifery education continues to reverberate around the web. Comments to her post and to Navelgazing Midwife's similar post range from supportive to "disappointed" to spluttering indignation. Kneelingwoman continues the conversation by asking some very important questions:Why don't we want to know what women want? Why do we keep going to conferences and paying out a ridiculous amount of money to stand in a circle, sing and hold hands with the "ya ya sisterhood" and then flatly reject the idea that we should create a midwifery that actually serves women according to their needs in birth instead of what need to provide? Why are we so afraid to grow and change? Why does the very idea that the reason midwifery isn't reaching more women that there is something about it and us that doesn't resonate with the majority not addressed more seriously?Why? I'll offer a very simple answer. Homebirth midwifery is about the midwives, not the patients. Not every single DEM feels this way, but the structure of the profession makes it obvious that it is the needs of the midwife that comes first.
When you think about it, it explains a lot.
"Why don't we want to know what women want?"
They don't want to know because they are not interested. The overwhelming majority of women are looking for something very different than what most DEMs are interested in giving. They want healthcare providers who are up to date with the latest medical information and who can provide the safest possible care. DEMs want a friendship and bonding over shared philosophical views.
"Why do we keep going to conferences and paying out a ridiculous amount of money to stand in a circle, sing and hold hands with the "ya ya sisterhood" and then flatly reject the idea that we should create a midwifery that actually serves women according to their needs in birth instead of what need to provide?"
Why? Because the conferences are designed around the needs of DEMs and they want to attended conferences that are nothing more than echo chambers for the views they already hold.
"Why are we so afraid to grow and change?"
Growing and changing means confronting the very serious deficiencies of homebirth midwifery education and training. The concept of growing and changing implies that there is actually something more to know than "trusting" birth. Growing and changing means responding to the needs of others, rather than determining who you will care for by whether they meet your needs. Growing and changing implies standards and standards are anathema to those who are undertrained.
"Why does the very idea that the reason midwifery isn't reaching more women that there is something about it and us that doesn't resonate with the majority not addressed more seriously?"
Most DEMs are not interested in reaching more women. They are not interested in providing healthcare. They do not want to try to meet diverse needs of women with different ethnic, cultural, economic and educational backgrounds. They want relationships with women who will echo back DEMs' flattering views of themselves, not patients who question, who disagree and who are non-compliant.
I suspect that both Kneelingwoman and Navelgazing Midwife are correct that direct entry midwifery is on its way out because legislators and consumers will discover just how uneducated and untrained DEMs are. Yet the lack of education and training is not just the problem, it is a symptom of the larger problem. It is virtually impossible to create a profession around the notion that you don't have to do anything more than "trust" that everything will work out fine. In an age when teachers are required to have masters degrees, it is simply not possible to maintain that attending births requires little more than a high school education. Finally, and perhaps most important, the fundamental reality is that most women view midwives as healthcare providers, not new friends. They are not looking for the relationship that DEMs want to give; they are not looking for friends at all; they are looking for professional health care.
Labels: midwifery, philosophy
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