The word “midwife” has many different connotations depending on perspective. Some see  midwives as healers and helpers. Some see them as skilled and wise. Some see them as agents of women’s empowerment. However, because of the history of midwifery and its relationship with class-perception, many see midwives as uneducated, old, primitive women. Before hospital birth was normalized, “granny” or “traditional” midwives were largely responsible for attending births, which typically took place in the home. This was the case for women of all classes in many different countries, developed and less-developed. As hospital birth became more common in the late nineteenth century, middle and upper class women began delivering in hospitals, but poorer women continued to deliver at home with a midwife. This (along with campaigns by hospitals involving ads like the one at this link: http://tinyurl.com/filthymidwife) led to a stigma against midwives that continues to distort society’s perception of midwives in developed nations, who were most influenced by the hospitalization of birth.

In reality, although contemporary midwives do have similar practices and philosophies to traditional midwives, the work of midwives today is largely influenced by the medicalization of birth. Most midwives in developed nations are nurse-midwives, who have had training in a clinical setting (State of the World’s Midwifery Report). Nurse-midwives practicing in the United States and in more remote areas of the world incorporate the philosophy of traditional midwifery with common hospital practices; for example, nurse-midwives attending home births are often equipped with pain medication, pitocin, or other medical supplies. They also often partner with hospitals in case of a need for emergency hospital-transfer. Interestingly, modern midwifery care also mimics the trend of hospital normalization by serving primarily middle to upper-class, white women. This article discusses the midwife-preference among white, affluent women and why it matters: http://nursingclio.org/2012/06/28/designing-women-midwives-class-and-choice/.

A key aspect of the midwifery model of care has stayed the same throughout generations: midwife-attended births result in less prevalence of medical interventions. A midwife’s philosophy is that a woman has the power to labor and deliver in most cases without medical interventions, such as C-sections. Midwives teach their patients to be confident in their ability to labor and are unlikely to recommend a C-section unless it is medically necessary. The World Health Organization recommends that a nation’s C-section rate be 10% or lower. However, a 2010 WHO study determined that only 54 countries out of the 137 countries sampled have C-section rates below 10%. The same study determined that out of 9.38 million C-sections performed in 2008, 6.20 million were medically unnecessary. This resulted in an excess of over $2 billion spent, and thus WHO identified unnecessary C-sections as a barrier to universal coverage of care (http://www.who.int/healthsystems/topics/financing/healthreport/30C-sectioncosts.pdf). It is no coincidence that WHO recommends midwives as a way to improve global maternal care. Midwives reduce the number of unnecessary C-sections, preventing surgical complications and saving money.