Midwifery: A Philosophy Not a Function


In planning to write my “first” editorial as Deputy Editor of the Journal of Midwifery and Women's Health, I reflected on the 24 years I have served as an associate editor of this journal and the many editorials I have written in that capacity. As I reviewed those prior editorials, written over two decades, I am struck by how dated some have become. The first editorial I wrote argued for prescriptive privileges for midwives, an issue long settled in most jurisdictions.1 Several years later, I introduced a home study program that was focused on well woman gynecology and argued that such care was as much a part of midwifery as attending births.2 This concept, too, has become part of the “midwifery mainstream” scope of practice. More recently, I made the case for evidence-based practice in midwifery, a call that is no longer needed in these days of evidence-based decision making.3

But one theme has reappeared in several editorials over the years, and it is timeless in its expression. What exactly is a midwife? Is it what we do: attend pregnant women during the joyous moments of childbirth? Or, is it how we do what we do? What is it that defines a midwife? What is it that distinguishes midwives from other clinicians who care for women?

In one of the first editorials I wrote in this space, I defined midwifery as “a belief in women … a respect for their being and their potential, and a commitment that stresses the support of health [and] normalcy.”4 Three years later, I asked similar questions when defending the argument that gynecologic care was an essential part of our practice: “What do we expect from a midwife? Is it delivering a baby or is it the acknowledgment of the woman's right to know and her right to choose and control her health care…?”2 I went on to state that “what we expect from a midwife is the promotion of self-determined health and normalcy…,” finally summing up that “we are… advocates for…women.” As Helen Varney Burst has said, “real” midwifery is with woman, wherever she may be.5

“With woman.” That is the essence of midwifery. More than a job, more than a profession, midwifery is a philosophy; it is never just afunction. It is how we approach the women we care for, in pregnancy, at birth, at menopause, and at all the stops on the journey in between. It is what makes each of us a midwife even if we do not attend births. I suspect it is also how we relate to our individual families and significant others and how we parent our children. It is “being present” to the other, to ourselves, and to the mutuality of the relationship that is created by being “with” someone.

The narrative analysis in this issue of the journal by Holly Kennedy and her co-authors6 exemplifies this essence in a way that moved me to read and re-read that article, thinking “yes, these are midwives!” The themes that were identified in this elegant study: the midwife in relationship with the woman, the orchestration of an environment of care, and the life journeys that result for both woman and midwife are the very fabric of my quarter-century in midwifery. Who among us will read the narratives in this thoughtful expression of who we are without experiencing every word as a reminder of the reasons we came to this profession? For those of us mired in the busy day-to-day shuffle of office hours and hectic labor rooms, for whom those reasons may somehow have been lost and replaced by questions like, “Why am I still doing this?,” these stories from exemplary midwives will remind us. This is why I am a midwife. This is who I am.