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The Oldest Profession

Midwifery - The Oldest ProfessionNo, it's not the profession that first pops into our minds that we've been jokingly told is the oldest one. Historically, it was the midwife, delivering babies at home, that deserved this recognition.

In most cultures throughout history, women have always given birth at home. The majority of women around the world still give birth to their babies in non-hospital settings. This is partly due to culture and a desire to be in a familiar, safe environment. In many areas birth is viewed as an integral part of family life.

With the advent of the Western concept of modern medicine, birth fell into the realm of a medical procedure. Childbirth became viewed as pathological rather than natural. Unnecessary, and often dangerous or unproven medical techniques and interventions became commonplace. Pain was alleviated pharmacologically and women were left alone for long periods of time. One study found that a woman with a low-risk delivery giving birth to her first child in a teaching hospital could be attended by as many as 16 people during 6 hours of labor and still be left alone for most of the time. Routine, though unfamiliar, procedures, the presence of strangers and being left alone during labor and/or delivery caused stress. Stress can interfere with the course of birth by prolonging it and setting off what has been described as a "cascade of intervention".

Western medical management caused the birthing process became segregated from mainstream family life. Human touch was taken out. Many were led to believe that the only safe birth was a hospital birth. Though doctors and their hospitals took credit for improved infant mortality statistics, in reality it was better nutrition, hygiene and disease control that improved outcomes.

The 1990s became a time of maternity awareness, a time when people were concerned with making the entire pregnancy and birth experience a family experience. Today, a carefully monitored homebirth, with women who have been helped to stay low-risk through nutrition and good prenatal care, has been proven to be very safe and successful.

Is midwifery safe? Every published study without exception shows midwives and homebirths to be safer than doctors and hospitals in low-risk pregnancies.

Are hospitals safe? According to the United Nations Statistical Office, the United States ranks 18th among industrialized nations for healthy births, at 10.7 infant deaths per 1000. Hospitals have never been proven a safe place to have a baby. Some members of the medical community have recently acknowledged that having a homebirth decreases the mother's and baby's chances of contracting an infection. The mother is used to the bacteria in her own environment and has built up immunities to it. This is passed on to the baby through the colostrum. Even when women are segregated in maternity wards, infections are much more commonplace after hospital births than homebirths.

The World Health Organization studied extensively the impact of place of delivery on outcomes and concluded that " a woman should give birth in a place she feels is safe, and at the most peripheral level at which appropriate care is feasible and safe. For a low-risk pregnant woman this can be at home…."

The legal status of midwifery is somewhat murky in Hawaii. Until a year ago midwifery was illegal in the State. At that time, an organization named the Midwives Alliance of Hawaii had a resolution accepted by the State legislature that recognized midwifery as a profession. This moved the profession from the "illegal" category and into the unsatisfying "a-legal" category. The Alliance is now focusing on securing licensing for midwives in the State.

The Hawaii Island Journal's own Kathryn Gibson recently gave birth at home to a daughter who was delivered by a midwife. Her husband, Michael, described the experience as "wonderful." The healthy baby was delivered by Jacqueline Hahn, N.D., a Hilo-based midwife who skirts the midwife legality issue by also being a Hawaii-licensed naturopathic physician.

Dr. Hahn is definitely a throwback to the days when the country doctor did everything from making house calls (she does), doing urgent care (she also does) and delivering babies. She has been on the Big Island for two years and has delivered 30 babies. She says that her physician-level knowledge and experience gives her an edge over lay midwives, although there are many excellent lay midwives who are also medically savvy.

Dr. Hahn says that a home-based delivery by an experienced midwife is a very empowering process and a spiritual experience. She adds that in a hospital you are "told what to do," while in a home birth medical management is less procedural with all energy going into a healthy birthing process.

If you are considering using a midwife, it is important to remember that midwives have varying levels of expertise and styles. Choose a midwife with whom you feel confident and compatible. Write down your questions before interviewing a midwife. Remember that the midwife you select will be sharing some of your most intimate moments.

Jacqueline Hahn, N.D. 969-7848
Midwives Alliance of Hawaii, PO Box 1132, Honokaa, HI 96727

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