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[edit] Midwives provide care

The entry reads:

Midwives provide care and support to expecting mothers. They deal with normal births, and are trained only to recognize what is abnormal. If something abnormal is discovered, the patient is sent to an OB/GYN, as midwives are not trained surgeons. They do receive medical training as they are RN's.

What does OB/GYN and RN mean? and is midwifery the proper heading for this entry? --css

OB/GYN=obstetrics/gynecology / obstetrician / gynecologist

This is not correct. Midwives are trained to perform all normal birth functions from early pregnamcy to about 6 weeks after deliver. A midwife will refer to a specialist medical doctor (Obstetrician) where it is apparent that a pregnancy is deviating from normal. There are rules around this. However deviations from normal are not always apparent and all midwives are trained to handle emergencies and can complete a delivery where other services cannot be accessed in time. For example an unexpected breach birth. --ghi

Some midwives in the USA trained as nurses first. Other did not and are not RN's or anything related. Midwives in many other countries are not related to nurses or other health practitioner types, do not undertakeany nursing training and do not perform any nursing duties. --ghi

Seems to describe modern midwifery in the U.S. It needs to be expanded to historic and worldwide. --rmhermen

Whats a "non-MD"? I know, you mean someone other than a medical doctor / physician--so why not just say "other than doctors"? "MD" is rather obscure, and is an Americianism. (Australian doctors don't have an MD, they generally have an MBBS). -- SJK

What is an Australian "MBBS"? The definition is not apparant. Possibly "Masters" degree of something.--TGC55 16:54, 3 April 2007 (UTC)

Nah, it's a bachelor degree of medicine and surgery (have fun working out the initials for yourself) but this just further underlines the issue of people not knowing what an MD is, outside the US. In fact, in the UK it means a managing director. 88.108.247.21 16:19, 6 July 2007 (UTC)

This is not NPOV. This is propaganda:

All midwives believe that birth is a natural process. In general, midwives perform births without painkillers, epidurals, or labor-inducing drugs. While some do use drugs in emergency situations to stop hemorrhaging, others use herbs and massage in place of all drugs. Midwives were early adopters of the water birth method and birthing chairs. In general, midwives cut down on postnatal complications by letting births proceed naturally, so jaundice commonly caused by labor-inducing drugs (needed because epidurals inhibit contractions), and requiring additional hospital stays is much less common with midwife assisted births than births done with an obstetrician. Postnatal infections are also much less common in mid-wife assisted home births than in hospital births. In hospital births with nurse midwives, statistics show bigger and healthier babies, less use of pain medications, less complications.

-- SJK

It's mostly true. Hospital-Acquired Infections are very real and very serious. The home may contain many more germs, but they are mostly uninteresting germs. You can catch some pretty exotic stuff at the hospital. Hospitals rush things for many reasons, with little concern for injury because a surgeon can "fix" things up afterward. For my first child, the birth was rushed because the doctor's home was flooding and because an 8 PM cut-off point (for insurance purposes) was being approached. The doctor even yanked on the umbilical cord, causing lots of blood loss. I have a friend who got a truly horrible episiotomy so that the doctor wouldn't miss his golf game tee time slot. Hospitals are rather quick to suggest drugs of all sorts, even to mothers that aren't requesting them. If labor stops when at home, the midwife will just come back some other day. A hospital would typically force the labor to continue or just operate; they can't stand to have a woman show up 5 times without producing anything. Epidurals do inhibit contractions; even the hospitals admit this. It would be surprising if statistics didn't show bigger and healthier babies, because babies grow more (duh) if you don't start labor early or surgically remove the baby before the birth would naturally happen. Hospitals also estimate age wrongly; for example the large babies in my family throw off the hospital estimates by 2 or 3 weeks. A midwife would generally not decide to force an early birth based on such estimates, while a hospital would. AlbertCahalan 00:41, 26 May 2005 (UTC)

I almost agree. Most of it is propaganda, but I don't see anything objectionable about this part:

In general, midwives perform births without painkillers, epidurals, or labor-inducing drugs. While some do use drugs in emergency situations to stop hemorrhaging, others use herbs and massage in place of all drugs.

--KQ

Untrue. My wife is a midwife. Midwives perform most births in the UK and they most certainly make use of drugs, epidurals, callipers, etc. Derek

Well, it does say "in general" and "some"; I'm not professing to be an expert on midwifery. What I meant was that those bits above don't push an apparent agenda as much as the rest of what SJK removed. And, BTW, "some" in terms of logic means nothing more than "at least one." :-) --KQ

Fair enough, KQ, but for everyday English usage rather than logical usage, "in general" and "some", get the emphasis completely wrong. If the text had said

A minority of midwives perform births without painkillers, epidurals, or labor-inducing drugs. While most do use drugs in emergency situations to stop hemorrhaging, a very few use herbs and massage in place of all drugs.

it would have been closer to the mark (for the UK anyway). Derek

Well, as I said, I'm no expert. Do you know about the trends worldwide? Because I imagine--and I have no evidence to back this up, mind you--that in fact "most" (in the typical sense) midwives would not use drugs, once you factor in all the midwives in third-world countries. --KQ

You could well be right. I can only claim to know a little about the UK situation. Of course once you start talking about the global situation, you then have to decide whether to count all women who are carrying out midwife functions, or just those who are, in some way, accredited midwives. Getting indisputable information could prove tricky. -- Derek

Would it be fair to say that nurse-midwives or midwives working closely with a physician are more likely to use painkillers and other drugs, whereas those not working with physicians often don't? Also, I think that midwives that specialize in home deliveries for "normal" pregnancies would be less likely to use drugs. Also midwives in Third World countries are probably less likely to use drugs, simply because of availability. There is at least a subset of midwives in the United States that does avoid drugs, and that does promote the deleted propaganda. Wesley

Being picky I'd say that a very tiny percentage of midwives use painkillers while delivering babies... it's the pregnant woman that uses them! ;) Well that said the number of stress headaches my fiancee has... But anyway most situations have the woman not wanting drugs but succumbing at some point. As for third-world countries I don't think they're really midwives as they haven't gained the qualification, though they perform the role of a midwife. violet/riga 10:40, 14 Aug 2004 (UTC)

Those people in 3rd world countries (and also in parts of the USA and elsewhere) are properly called direct-entry midwives (DEM) or lay midwives. They fit the international definition too. See here. AlbertCahalan 05:29, 27 May 2005 (UTC)

You have got this completely wrong. Direct entry midwife is the term for midwives who have trained only as a midwife. This is the situation that applies in nearly all advanced countires. Registered midwives in third world countries (most but not all will have a registration system) are almost never direct entry midwives. They are usually an advanced nursing specialisation. The USA has both types as explained in the article. Lay midwives are something else and are arguably not midwives in the sense being used in this article. --gmi —Preceding unsigned comment added by 125.236.196.95 (talk) 04:49, 16 October 2007 (UTC)

[edit] Direct Entry

Requesting permission/opinion to add clarification/wikilink regarding "Direct Entry" of "Direct Entry Midwifery" The article seems to assume you know what this procedure is refering to as defacto knowledge. I had to do several searches to find an adequate definition at Medterms as "Direct-entry midwife: A midwife who has entered the profession of midwifery as an apprentice to a practicing midwife rather than attending a formal school program." To me where it talks about the Missiouri conflict that made no sense without an understanding of Direct Entry versus coursework midwifery. Halcyonforever (talk) 02:52, 26 February 2008 (UTC) Oh, link to definition www.medterms.com

In Australia, it is the absolute opposite. A direct-entry midwife is one that goes to university to learn midwifery and does NOT learn nursing first, and then transfer to midwifery. Midwives who were apprenticed to other midwives are called "Lay midwives" and are generally not allowed to work in Australia. Gillyweed (talk) 05:30, 27 February 2008 (UTC)

Permission denied (if I can do that) because your definition is incorrect. Gillyweed has the correct answer. The relationship between midwives and nurses has varied considerably over time and between different countries. In most first world countries they are separate professions. The USA is a notable exception where the majority of midwives (about 5/6ths) could be regarded as nurses with an advanced specialisation. Direct entry midwife is a term used for a midwife who trained for that profession without doing any nursing training (they don't perform any nursing functions so why would they need any nursing training). The training programme in most countries is three years at a university or similar level institution (the same as nurses). In the USA (not in other countries) it is possible to become a registered Midwife (CPM) without completing a formal degree. However the training they receive is evaluated and must meet the same standards before they can be registered. They are a minority and most USA direct entry midwives will have a formal qualification. The term is used to refer to a trained midwife and is not used to denote unqualified or lay birth attendants. That association would be insulting to a direct entry midwife. (ghi) —Preceding unsigned comment added by 125.236.196.95 (talk) 03:29, 29 May 2008 (UTC)

This is wikipedia; one does not need to ask permission to edit, nor does anyone have the authority to deny someone the permission to edit! That said, I think we should be careful about defining terms in such a way that introduces geographic bias, and I think Gillyweed and the other user are making good points. This is definitely an area where different definitions are used in different regions. It seems to me that the most constructive course of action here would be to find reliable sources referencing the different definitions, and then citing those sources if and when they are used. I want to point out that different sources in the U.S. do not even agree. For example, [1] defines a direct entry midwife as "A midwife who has entered the profession of midwifery as an apprentice to a practicing midwife rather than attending a formal school program.". However, other sources, including [2] use the term direct entry midwife to encompass all midwives who have not attended a nursing program (but may have attended a formal school program in midwifery). The second source would classify CPM's (certified professional midwives), certified midwives, licensed midwives, and lay midwives as direct entry midwives...in short, anything other than a certified nurse midwife. Rather than pick a definition and choose one, I think we should avoid using a term like direct entry midwife in any potentially ambiguous usage...and instead use other, more specific and less ambiguous terms. Does anyone here understand the full context of the usage of that term? If we cannot figure it out I propose pairing down the comments to what we do know. Cazort (talk) 04:30, 10 August 2008 (UTC)

Is it just me or does it seem like there's almost some sort of conflict here, with the more "medically" oriented sources attempting to define the term in one way, and organizations more oriented towards midwifery trying to define it in another way? Call me paranoid but it seems almost like the medical establishment is trying to run a smear campaign. Cazort (talk) 04:34, 10 August 2008 (UTC)

I think that UTC has it about right, but perhaps from a USA point of view. I would add that in most first world countries excluding the USA (The EU counties, Canada, Australia, New Zealand) midwifery is a regulated profession in equal standing to other health practitioner groups. All midwives practising in these countries must be formally (and medically) trained to the same standards for the profession in those countries. There the use of the term direct entry is intended to distinguish between midwives who trained only in midwifery and those midwives who entered the profession via nursing. Some nurses do still move into midwifery now but the combined training requirements would be very high so the number would be small. Generally direct entry is the current route to this profession and the route via nursing was the old historical system.

The situation in the USA as I understand it is more confusing. Certified Professional Midwives (direct entry – can be formally trained or can have other routes) are accepted in some states but not in others. Certified Nurse Midwives are accepted everywhere. However the profession as a whole is not as established as in some other countries. For example in New Zealand about 80 percent of women would choose a midwife to provide their care during pregnancy and birth. In the USA about 5 percent of births involve a midwife (can someone correct if this is not right). ghi. —Preceding unsigned comment added by 125.236.196.95 (talk) 23:24, 1 October 2008 (UTC)

[edit] Homefirst Health Services

I would like the opinion of fellow Wikipedians. Ombudsman has linked this article on Homefirst Health Services to this article. Firstly, I am not convinced that na article about a specific medical practice is appropriate for Wikipedia. Secondly, it reads more like an anti-immunization site and an advertisment for the company than anything much to do with midwifery. I removed the link and Ombudsman reverted it. Before I remove the link again, I would appreciate the views of a few other people. I don't intend to get into a revert war. Maustrauser 07:02, 12 December 2005 (UTC)

Homefirst, which specializes in home childbirth and provision of health services in the home, is the type of practice that has been all but vaporized in the West due to the political lobbying, profiteering and ham fisted marketing of 'modern' medicine. It is none too surprising to find a Wikipedian has already vaporized the Homefirst link as well. Readers should be given a choice whether or not to learn more about patient benefits derived from a medical practice that balances medical integrity with harsh economic and social realities. Suppression of common sense is often the result of such realities, symbolized in this instance by the prompt deletion of the Homefirst link. Elimination of vaccine injuries is not the only benefit for Homefirst's patients, who avoid many more obvious hazards of Western medicine. Home care is far less traumatic and inherently less likely to result in invasive medical procedures, such as c-sections. While c-section rates have soared well over 20% in the US, despite all manner of contraindications, Homefirst has struck something of a balance in keeping such cases to 5%. But statistics, like the zero autism rate amongst Homefirst's unvaccinated clientele (for contrast, in China alone, thanks to vaccines, the autism epidemic afflicts 1.8 million children), tell only part of the story. The Wiki's medicine articles are plagued by compartmentalization, sanitization, and obfuscation, while critiques and alternative medicine articles are typically given short shrift. Narrowly focused articles, like statistics, tend to lose their integrity when real world examples are excluded, and to offset that, a link to the Homefirst article offers a perfectly good example, showing what happens when midwifery is practiced in lieu of Western medicine. Ombudsman 08:39, 12 December 2005 (UTC)

Thank you for your comment. I assume you would have no objection to me writing up advertisements for the Canberra Home Birth Service, the Ryde Homebirth Service, the Melbourne Home Birth Service as well as the Berrima Naturopathy Clinic, the Backofbourke Homeopathy Drop In-Centre etc? All are commercial enterprises just like Homefirst Health Services. All have a 'different' slant on what is scientifically defensible. All make claims not based on accepted evidence-based practice. However Wikipedia is not an advertising hoarding. Further, before you attack me for being anti-home birth, pro-caesarean and pro-intervention, you may wish to examine my contributions to home birth, pregnancy, childbirth, obstetric ultrasound etc. In all such cases I have added the scientific evidence that supports lower intervention and reduced meddling in birth. What I particularly object to is the mixing of homebirth with anti-vaccination rhetoriic. However, I await the commentary from other Wikipedians... Maustrauser 09:34, 12 December 2005 (UTC)

Ombudsman is the most vociferous anti-vaccine editor on Wikipedia, and this tactic is not isolated to midwifery. Have a look at Wikipedia:Requests for comment/Ombudsman for a discussion. JFW | T@lk 19:41, 12 December 2005 (UTC)

The link to Ombudsman doesn't work. Could you check it please? I don't believe that it is appropriate to link to Homefirst as I agree with Maustrauser that its advertising. I actually think that Homefirst should be deleted. Mirasmus 02:02, 13 December 2005 (UTC)

I've fixed it now. Ombudsman has a subtle but definite anti-vaccine (and anti-a-lot-of-other-things) agenda. Just because he wrote a page on Homefirst does not mean it should be included above many other similar services that do not have a link with the anti-vaccine movement. JFW | T@lk 08:54, 13 December 2005 (UTC)

[edit] US POV

The article seems at present to represent a very US (legalistic) point of view. Perhaps UK midwives fall into the category of traditional birth attendants. I imagine that if working in the US a UK midwife might be recognised as a nurse widwife, but that itself seems to be a very US expression/concept, quite unknown in the UK. Somewhat surprised there is not an article called obstetric nurse. (Or is nurse midwife a new title for the same qualification?) Laurel Bush 16:45, 12 December 2005 (UTC).

UK midwives are not the equivalent of the USA Certified Nurse Midwife. If anything they would be the equivalent of the Certified Professional Midwife. In the UK midwives are a separate profession from nurses. Although some nurses (and other professions) are attracted into the midwifery profession most midwives train directly and have no nursing training or background. A matter of terminology but traditional midwives would generally be taken to mean a self taught midwife without any formally recognised training or regulation, the opposite of the system that applies in the UK. Obstetric Nurse is a technical term that will mean different things in different countries but refers to a type of nurse, not a midwife. gmi

not quite. midwifery used to be a conversion course, and many UK midwives are nurse-midwives as they were trained under the old system. CPMs practice solely in out of hospital settings (primarily home births), don't have university-level training, and are not integrated into the health system as a whole. The conditions of practice of British midwives are much more like that of American CNMs. 217.44.196.10 (talk) 02:48, 2 August 2008 (UTC)

[edit] Midwifery in Canada

I deleted/revised the last two paragraphs of the section on Canada because they don't seem to be NPOV to me. My mother is a midwife in Canada and I found them to be personally insulting to her and other currently practicing Canadian midwives. We have tried a rewrite, but would be happy to see someone else take a crack at a more neutral version if they don't think it passes muster. Thanks.Melsod 22:18, 26 April 2006 (UTC)

I have removed the sentence referring to the R v. Sullivan case because it doesn't seem that the fact that the caregivers in the case were midwives was relevant to the ruling itself (regarding the status of a fetus), based on the wikipedia entry for that court case. The sentence in the Midwifery in Canada section, as currently worded, seemed to imply that the ruling was about midwives. I could see an argument that referring to the case is worthwhile because it's a historical court case that involved midwives, but not as currently worded.Melsod 03:24, 31 August 2006 (UTC)

[edit] Spelling Conflicts

I've moved the British spellings to American spellings because as the article stood before there were both American AND British spellings. While I understand both forms are accepted and "one doesn't change from one to the other," having a conflict of styles within one article looks sloppy. --Bri 04:58, 13 March 2006 (UTC)

Whilst it looks sloppy, it really pisses off one side or the other. By going to US spelling you annoy the Poms, the Canadians, the Australians and the New Zealanders. By going to British spelling you annoy the US audience. Sloppy or not it should remain as is. As an author of parts of this material, I'm willing for my writing to be amended left right and centre (center) but not my spelling! The reason for the Wiki policy of having both spelling systems as acceptable is to avoid irritating other authors. I think it is a fine policy and I am reverting to the mish mash we had earlier. Maustrauser 05:19, 13 March 2006 (UTC)

Bri/Yorick8080, you are better off leaving well enough alone. Changing one spelling to another is just a waste of time. Spelling (correct English/American) is not a "style", it's spelling. BTW, do you have a problem with correct British spelling? --TGC55 17:07, 3 April 2007 (UTC)

I changed "Midwifery Education Programme" to "Midwifery Education Program", because that's how it's listed on their own website. Melsod 22:10, 26 April 2006 (UTC)

I am not going to go into the US section and change all the spelling to the correct English version. I would appreciate the same courtesy thanks.

[edit] Midwifery Organisations

I am concerned that the list of midwifery organisations is getting very long. How about we determine that we only have one organisation per country (unless the organisations are competitive?). Eg Having the Ontario Midwives Asscn when there is also a national Canadian organisation looks pretty messy to me. Imagine that if every US State org is listed. That's fifty organizations. Any opnions? Cheers, Henry Maustrauser 05:22, 18 September 2006 (UTC)

Generally agree, except with provisos of:

There may be both an official national regulatory body and a main membership body (e.g. compare in UK General Medical Council and British Medical Association)
If a particular body has a notable different stance on an issue that the article feels warrants mentioning in this a worldwide encyclopaedia, then a link to that organisation seems appropriate. David Ruben ^Talk 10:39, 18 September 2006 (UTC)

Sounds a good policy to me. I'll wait a few days for additional comments and then delete some of the links. Maustrauser 10:47, 18 September 2006 (UTC)

I'm OK with this (you make a good point about it getting messy). As a counterpoint though, the development of midwifery is not a uniform process across different countries or even different provinces or states. Therefore, the national association may not be a particularly representative organization for what's going on in different provinces/states. Assuming that the national organization website itself has links to more local provincial/state organizations, though, having the link to the national organization is probably adequate anyway. One thing that might help with the messiness is to put some of the external links in the text itself? Or is this bad practice? Perhaps reference to a separate Wikipedia page on (e.g.) Midwifery in Ontario, with a link to the Provincial association on that page? Anyway, just some alternative ideas to preserve some of the external links while reducing messiness. I'm not attached to these, necessarily. Melsod 16:51, 20 September 2006 (UTC)

[edit] Female hysteria

The Female hysteria article says that in the past, midwives where sometimes used to treat "Female hysteria".. should that be mentioned in this article as well? 151.203.164.46 04:02, 2 January 2007 (UTC)

[edit] Defining Midwifery

The wording on the section that gives the WHO definition is a little confusing at the end. Did the international midwives organization adopt the WHO definition, or is this referring to a separate definition? If the latter, what parts are the WHO defition, and what parts are the other definition. If someone in the know could clarify this, that would be great. Thanks! Melsod 22:22, 22 February 2007 (UTC)

Hey guys, sorry I don't know how to do it, but I figure if I write it here someone will fix this for me. The Japanese link for Midwife is here: http://ja.wikipedia.org/wiki/%E5%8A%A9%E7%94%A3%E5%A9%A6

I couldn't figure out how to make the link...someone else help please —Preceding unsigned comment added by 76.111.70.37 (talk) 02:05, 4 September 2007 (UTC)

[edit] Request: Doula vs. midwife?

I would like to request for someone who knows more about these subjects to add material on this page, as well as on the page for doula, explaining the differences and similarities between a midwife and a doula. Cazort (talk) 23:23, 5 February 2008 (UTC)

I'd be happy to clarify, would you like posts on both pages? -mleinber

Sorry. I've removed your post about doulas from this page. If people want to know about doulas they can go to Doula. A simple wikilink is better than another exposition. Cheers Gillyweed (talk) 02:36, 20 February 2009 (UTC)

[edit] Practice in the United States

The large sections removed were copied verbatim from Our Bodies Ourselves[3] without attribution and seemed to well exceed any reasonable quotation length. I don't have time to rewrite it from a neutral point of view right now.

As to the rest, it's horribly vague and I don't see anything that backs up the implication that a lack of midwife-assisted births causes a high mortality rate.

Sistermonkey (talk) 05:50, 7 November 2009 (UTC)

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