labor nurse has been reborn and shares her experiences as a new nurse-midwife, woman, and blogger

Tuesday, May 19, 2009

On "Medwives"

I've seen and heard this term quite a bit. I am sure most of the readers here have heard of it at some point, but for those wondering "what is a 'medwife'"- it is typically a derogatory term referred to nurse midwives who practice with a medical model. I've worked with a some at various points in my nursing career who were labelled as such, and have even heard some call any midwife who chooses the CNM route or any midwife who does birth in a hospital as a "medwife".

I will admit that I would personally find it insulting if someone called me a "medwife" because I went into midwifery to protect the right of women's normal life experiences with childbirth and such. My personal philosophies do not align with the medical model of childbirth for normal, low risk women (which is the majority of those giving birth). But, I have used medical technology in caring for laboring women both as a nurse and a student midwife (and soon to be practicing CNM!). I don't view this as a bad thing, but for some it would put me in the "medwife" criteria just for the sheer fact I have used medical technology. For instance, if a women truly wants medication, an epidural, or whatnot- I'm okay with that- although you all know my pet peeve is women not taking the risks for such things into consideration. I've cared for women as a student midwife who had prenatal complications that medical intervention was called for in some way. But does this mean I can no longer be truly considered a "midwife" in the spiritual and literal sense? I say- hell no!

But as I've said, I've seen what most refer to as "medwives" in practice. Not often, but it does exist. However, I think many times CNMs get labelled incorrectly as "medwives" because they work in hospitals that have high levels of medical childbirth care. I've come to see this as something that is inevitable in this push/pull type struggle between the obstetrics and midwifery cultures. Turf battles, if you will. Many times if a CNM wants a job, and wants to serve women and their families, they have to enter into such environments. I think for these CNMs, its a necessary part of trying to be a change agent in those medical models. Like, a group of CNMs who finally manage to get a practice going at a hospital that for years and years was only attended by old school obstetrics start by changing little things in the care- like no routine IVs in low risk women, and then no continuous monitoring on low risk women, etc. And over time, all these little changes add up and have changed the culture of childbirth care for that hospital. Sometimes going into an environment like a bull in a china shop does not work as effectively, as much as you want to turn things upside down to make it immediately midwifery friendly. So.... I don't know. Sometimes seeming to be a "medwife" might be necessary given the situation and environment until things really start changing.

I think the "medwife" thing is a double edged sword when it comes to nursing, too. Nursing staff have a strong influence on the care environment. There are plenty of nurses who provide care to laboring women as if it were a disease. Many do not feel comfortable unless monitors and IVs are strongly involved in the process. So imagine a midwife trying to do things that go against what the nursing staff is comfortable with. That's tough- but at the same time if the midwife is doing things that lean towards a medical model of care- then she is called a "medwife" by the same staff. I've seen this plenty, too.

So what are your thoughts on this? What do you view as a "medwife"?


Jennifer said...

We have a "medwife" at our hospital- all pts get an IV, all pts get continuous monitoring, likes to AROM everyone on admission, etc. She has similar outcomes to the OB docs and frequently has to transfer care due to non-reassuring FHT, possible need for C/S, etc. She never stays with her pt if she transfers care! Very frustrating.
I am an RN going for my CNM as well, and while I hate a lot of our hospital's policies, I work there and have to abide by them! But at least I am educated about other options and ways of giving birth. Some of our new nurses think all pregnancies are high-risk and scary!

MomTFH said...

Not all medwives are CNMs.

I know of a birth center with LM (our state's equivalent of a CPM or direct entry midwife) medwives. They used to use pitocin for augmentation routinely, were aggressive with AROM and fundal pressure, and even supposedly gave women cytotec tea and surreptitiously used a kiwi vacuum extractor. What's worse is a lot of this was done without informed consent.

I have nothing wrong with knowing when to do appropriate interventions that are medically indicated. I think informed consent is key. I have a strong bias against interventions that have poor health outcomes for the mother and baby but somehow make it easier, logistically, for the birth to happen in a hospital or busy midwifery practice.

Haylee said...

"Medwives" are midwives who may as well be OBs. Their view of birth is not a natural approach and they push medical technology and interventions that are unnecessary. This is what I would consider a "medwife", although I have been fortunate enough to have not met one yet (that I know of, at least)!

I support CNMs though because had it not been for a CNM, I would have been stuck with a lousy DO-OB that was pushing an unneccesarean on me during labor. Mid-labor, we finally kicked the OB out and had a CNM sent up from the same practice. And although my mind had gradually been moving toward having a midwife attend my birth, (I was raised in a very medically-minded home and family) this experience sealed the deal and I have no plans of EVER going back to an OB for any form of womens' care. It would definitely take a serious emergency for me to switch to an OB, and then I'd go back to how I like things...with a midwife.

So, although some people may view CNMs as "medwives" just because they practice in hospitals, or because they had a nursing degree to start, or whatever, I am grateful for them and that they provide a middle ground for those who want midwifery care but aren't ready or interested in any other form of midwife.

womantowomancbe said...

The difference between a "madwife," "midwife" and "medwife" is completely in the eyes of the beholder. To many unassisted birthers, ANY midwife who is a CNM or who practices in a hospital is automatically a medwife; also, many non-CNMs may also have the term "medwife" cast into their teeth if they do not fully and completely support someone wanting to UC (for instance, they want to be in the room during labor and/or birth, and take fetal heart tones from time to time).

But many of the above midwives would be labeled "madwives" by some people, who would use that term for ANY midwife who would attend a home birth or in any way deviate from the medical model of care.

Although labels can be helpful for quickly and easily showing what one is thinking, that does not necessarily reflect reality. Calling a midwife a "madwife" just indicates that she is not interventive enough in your opinion; and calling a midwife a "medwife" just indicates that she is too interventive enough, again, in your own opinion.

I would say that if a midwife's rate of interventions (particularly her C-section rate) is the same as a doctor's, then she may very well qualify for the term "medwife" -- but it may simply reflect that she is in a hospital where she cannot practice midwifery, and can only practice the medical model of care. Also, if a midwife has women or babies who suffer ill effects (or die) because she does not do the minimum safe things during labor or birth, then she may very well deserve the label of "madwife" -- but even in this, it may reflect that she is bound by the mother's wishes not to interfere, and the midwife prefers to at least be on hand, even without interfering, than to leave the mother to have a completely unassisted birth, and potentially greater harm come.


Heather the Mama Duk said...

A medwife is basically an OB with a midwife license. What you describe is not a medwife. Medwives see patients for 5 minute prenatals, push drugs, are induction happy, and show up to catch. Very different from the midwifery model of care. Interestingly, the midwife who delivered my second is a CNM and she said most of the women she went to school with fully intended to become medwives.

Reality Rounds said...

Medwives are wanna be OB's. They do not labor with patients, are always in a hurry, and get impatient very easily. The group of CNM's I work with, and who delivered my second baby, are not medwives. They stay with the patient the minute she is admitted, and provide very joyous births. Not just their birth experiences are great. I used to love seeing them for my prenatal checkups. It was like seeing a bunch of my girlfriends, always talking pregnancy and babies. Medwives have a way of making you feel not quite human.

Anonymous said...

As a woman pregnant with her third child I am all too familiar with "medwives". I have always practiced natural childbirth. I am low risk, the ideal model of health (physically fit, organic balanced diet). Yet with my last child and now this pregnancy the midwifery clinic I use (attached to Emanuel Hospital in Portland, Oregon) are alarmist. Everything warrants an ultrasound. Interventions are "necessary" they REALLY frown on women that do research make educated decisions for themselves and are actively involved in their care. These "medwives" really would prefer if I would just shut up and put up with all their interventions. Most women using their services do not want natural childbirth and therefore they are unaccustomed to women who not only want this, but demand this. I explained at my last appointment that "pregnancy is just a natural consequence of our actions." The "medwive's" response.... "and there are very serious consequences to pregnancy." is amazing any of us are here. Our grandmothers should have never been born and survived because these "interventions" just didn't exist. And "gasp" many had what 4 to 10 children..... Yes, I am bitter but it is all my insurance will pay for. So I don't put up but I have shut up...for now. I only have 7+ weeks to go.


Lost said...

Ok this is difficult medwives - midwives who have lost there way or just further educated nurses who know no different- or midwives try to move the heavy ball up hill.

All I know is that prcatising midwifery in USA id really hard to practise from what I have seen that does not mean that you cant its just hard.

Comming from somewhere midwifery is accepted to somewhere that at every turn people are questioning your safety at every turn and even thing that you are some mad freek is hard.
What do you do you tame your practise abit so it is acceptable to the masses that being staff- nurses obs and hospital community - ok do you keep pure to your roots and only off the select service to the already converted.

It is a diifficult path to take either way I am luvky that I have years of practise with in a midwifery model behind me but tothers are not so lucky. Instead of isolating midwives lets welcome them back help them find the path.

man-nurse said...

A problem here in Illinois is that once CNMs were legally recognized (an uphill battle, I've heard, since this state is the the seat of ACOG and AMA), it was recognized that in order to call yourself a midwife, you must be a CNM. And CPMs are not legal. So 'direct-entry' midwives are violating the Nursing Practice Act, rather than practicing medicine without a license!

And what resulted, as far as I've heard (not seen personally, though) is that the CNMs typically always work in hospitals and have a thoroughly traditional obstetric training and background.

On the other hand, I agree with MomTFH that CPMs and direct-entry midwives can be scary. I have family in a CPM-legal state who had a bad experience with a CPM "medwife" style practice. And they were subject to restrictive, non-evidence-based protocols, as if they were in a hospital (i.e. no going over 42 weeks, etc).

womantowomancbe said...

man-nurse brings up an interesting point for both CPMs and CNMs -- many times states that allow CPMs place such restrictions on them that they also cannot practice midwifery as they would like -- they must practice within protocols laid out by the legislature and/or their overseeing doctor and may not be allowed to attend certain kinds of births, such as, they must automatically "risk out" a woman who gets past 42 weeks. Some midwives may not have these restrictions, but choose to practice this way anyway, because they feel like it is safer.

This is why some midwifery advocates do not want CPMs to be legalized in some states -- because with legalization comes restriction; and they figure "better to be completely illegal or alegal and practice as you choose, than to be legal and not be allowed to practice as you wish."

CNMs face the same problems -- they may want to attend out-of-hospital births, but face such difficulty or pressure in doing so, that they really can't, for all practical purposes; or they may wish to follow a more midwifery-oriented model of care, but are forced to follow the medical model.