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The rebirth of birthcare: An enquiry on midwifery care

By Larissa Zanstra

‘The midwife tells the woman in labour that she sees she is having a hard time during the contractions. “The strength of them is good, after breaking the membranes you can definitely see a difference, their power is fine, it will come naturally”, the midwife says. The woman agrees that it is more intense now and that she did not sleep well lately. When the woman gets another contraction, it is silent in the room for a moment. “Well done, you can do this, you are already doing this”, the midwife encourages her.’ – Fieldnotes

Childbirth. Something that has fascinated me for a long time. The most natural miracle. For women, an important rite of passage. As Rachel Reed, a midwife herself, also explains in her book Reclaiming Childbirth as a Rite of Passage: Weaving ancient wisdom with modern knowledge, midwives have been playing a supportive role during women’s labour for centuries. Yet limited research exists about the support they offer, beyond the medical interventions they perform. Emotional support, encouraging words, and being there are important aspects of tailored, woman-centred care provided by midwives that anthropology can contribute to understanding.

As part of my Master’s, I took part in a trans-disciplinary collaboration between Ank de Jonge (VUMC Midwifery Science) and Giulia Sinatti (VU Anthropology). Together with them and other team members, we investigated ethnographically how midwives meet the needs of the women they guide. In this ongoing project, observations during births and interviews with midwives and new mothers allow to explore what is perceived as supportive during childbirth, with special attention to difficult to measure aspects. In much literature about what midwives do, the emphasis is placed on them carrying out medical interventions. A midwife, however, may “do something” just by being present and carefully considering not to carry out interventions. This is also extensively described in the article we as a team wrote together.

As this article demonstrates, recent literature in the field of midwifery science has become aware of this gap, and coined the term Watchful Attendance to point at as important elements in midwifery care such as continuous attendance, responding to women’s needs as well as monitoring progress to provide medical interventions in time and/or when needed. Understanding these elements of Watchful Attendance is important for creating recognition of the fact that every labour has its own rhythm, and for offering more individualized, supportive, woman-centred care during labour. Many women in the Netherlands experience giving birth as something traumatic (about 10 to 20 percent of all Dutch women, as Jacobs explains on, despite them having access to midwifery care and freedom of choice when it comes to birth – at home or in a hospital, medicated or unmedicated – provided that mother and child are healthy. This comes with the problematic consequence that birth may be perceived as something to be scared of and that women may lose their autonomy in this process.

There is therefore a need for research that can holistically capture the essential elements of midwifery care, both medical and non-medical. The work of midwives largely consists of emotional support, being there and radiating trust and tranquility. Moreover, their work is highly personal and adaptive and thus variates in different settings and in interactions with different women with each their own birth preferences and preferred ways of communicating.

One could say that standardization and medicalization (in the form of protocols and preliminary medical interventions, for instance) thus work against this flexible and personal type of care. Our data in fact showed that women felt more confidence and trust in themselves and their bodies when the midwife was actually doing as little as possible. Besides verbally and non-verbally expressing trust, confidence and keeping the peace, the simple presence of the midwife often was enough. Continuity of care, in which a midwife and a woman can build a relationship of trust prior to giving birth, also emerged as important. A midwife can better guide a woman during the birth itself when she has a better sense of what a woman might need in the moment. Watchful Attendance is much more more than just as care during the birth itself.

Further ethnographic research with observations and interviews is needed to provide a better understanding of this unique type of care. I am grateful for having embarked on this research journey during my Master’s. I experienced the birth process as the most natural thing, yet as something miraculous… which is why I think midwifery care is so important and worth fighting for: to keep it that way.

Are you a student and would you like to be part of this valuable research? Then email Giulia Sinatti, Department of Social and Cultural Anthropology. She will welcome you with open arms!

You can also watch the informative video we shared to promote the research among midwives.

Larissa Zanstra is an alumna of the Master programme Social and Cultural Anthropology at the Vrije Universiteit Amsterdam.

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