Midwives as Modern Birth Partners: An ancient role in today’s world explained

by Alicia Jerreat

Ever watched the TV series “Call The Midwife” with its retro vibes, or those sitcoms where someone’s water breaks (with a rush and a gush!), and it’s all hospital hustle and bustle? Well, in today’s world, you might be wondering: what’s the deal with midwives? Are they still a thing in the modern birth scene?

And with good reason! The culture and practice of birth have changed dramatically over the last century or so. My mother—let’s call her Suzanne as it’s her actual name—trained in Vancouver, BC as a nurse before deciding to become a midwife. At the time, midwifery wasn’t recognized as a medical profession in Canada so she traveled to England for training. Nowadays that is thankfully not necessary, as midwifery became a regulated health profession in BC in 1995, with the first midwives being registered to practice by 1998. So let’s dig in a little deeper.

How has childbirth changed and evolved over the last 100 years? Picture this: back in the day, experienced care workers without medical degrees, were those who attended the birthing scene. A bunch of folks—moms, grandmas, and wise old souls from the neighborhood—gathered around to help a friend during labor. They’d be armed with generations of wisdom and maybe a handful of herbs, guiding birthing people through labor like seasoned pros, a mixture of what we know now as midwives and doulas. 

Midwifery has ancient origins worldwide, dating back to civilizations like Egypt and Greece, where childbirth was revered as a natural and sacred process. In the Middle Ages, local caregivers handled deliveries, blending traditional remedies and religious practices.

In India, traditional midwives, known as “dais” or “doulas,” worked alongside Ayurvedic healers, integrating herbal remedies and spiritual rituals. However often the work of midwives went undocumented by the recorders and scholars of history, and there is much we do not know about the history of birth practices in some parts of the world.

On Turtle Island (known as Canada), midwifery boasts a rich heritage dating back to Indigenous cultures, where traditional midwives were the backbone of childbirth. Across different Indigenous groups, there was a shared commitment to holistic care and cultural traditions. These wise people wielded knowledge passed down through generations—herbal remedies, spiritual rituals, and birthing techniques. They didn’t just deliver babies; they provided emotional, physical, and spiritual support, often surrounded by the larger community. Birth wasn’t just a medical event; it was a celebration of nature and spirit, honoring the birthing person’s autonomy and strength. It was a beautiful tapestry of tradition and resilience woven into each birth.

The medicalisation of birth in North America emerged in the 19th century, as doctors began to practice and experiment with new procedures and surgeries aimed at improving the survival rate and increasing the birth yield of enslaved women after the ban on importing African-born slaves in 1808. The racialized beliefs of these medical doctors, such as Dr. James Marion Sims, dehumanized enslaved women in the 1800s, who were often trained to help as nurses but were primarily the subjects of the medical experiments. This led to advancements in safe surgical procedures and a greater understanding of gynecological health, of which the price paid by these women’s contributions was not credited or highlighted. 

In the 20th century, hospitals became the place to give birth, doctors and nurses, with new medical gadgets promising safer deliveries, while midwifery saw a decline. Midwifery itself became ‘alegal’, meaning midwifery was not illegal but midwives were not covered under health insurance and were unregulated. To be involved with delivering babies, training as a doctor or a nurse and then choosing to specialize in obstetrics and gynecology was the route, which was how my mother Suzanne started her journey to midwifery.

Suzanne began her nurse training in the early 1980s, studying and working in the different wards at VGH, including obstetrics. After some negative experiences with some of the labor and delivery practices of the time she said, “After my obstetric round, I hated obstetrics. At the end of the course, I walked into the common room and said I will never set foot on an obstetrics ward again.” However, when Suzanne went on to work at BC Children’s Hospital in the neonatal unit and came into contact with some English nurses who had practiced as midwives in the UK she found her mind changing about working in obstetrics. 

“I’d met more expat midwives, some of them came [to Canada] before 1971, so were very much of the “Call the Midwife” era,” she explains. “They did mostly home births, rode bicycles… I found it amazing… I thought ‘I quite like that’ and so I applied to go to midwifery school.”

Suzanne moved to London to complete an 18-month midwifery conversion course. She was inspired by the long-term care practices, the work in the community that midwives were involved in, and the research conducted by midwives. Such as their efforts to reduce medical interventions – such as episiotomies (which she says she only performed once or twice in her 30 years of midwifery practice!) and of the birther centered care. Particularly she noticed the amount of care given to the parent-to-be and how it was often provided by the same person from prenatal care to 28 days after birth, something that was very different to her experiences in Canada. 

Suzanne went on to practice as a midwife for several decades in the UK and was an advocate for home births and still is passionate about birther-centered care. As a child, I remember my mother being approached regularly when we were out shopping in the town by those whose babies she had delivered, families she’d supported through a loss or others she’d led through a prenatal class. Their gratitude and affection towards my mum stick with me still today – even as a child I had a clear idea of the importance of my mum’s work, it was obvious to me that there can be a strong bond between birthers, their partners and their birthing support.

In the late 20th century, there was a resurgence in interest in midwifery in Canada, leading to its legalization and regulation in several provinces beginning in the 1990s. Midwifery was often the only option for those giving birth in communities with no easy access to physicians and hospitals but now midwives were being trained and medically certified and, importantly, being covered by health insurance which has allowed a greater accessibility to healthcare for those both in remote communities and in urban environments.

In BC, the Midwives Regulation came into effect and the College of Midwives was established, with the University of British Columbia introducing its Midwifery program in 2002 and its first graduating class in 2005. 

Midwifery is now recognized as an essential component of reproductive healthcare worldwide. Despite regional variations, traditional midwifery endures across the globe, remaining essential in childbirth support alongside modern healthcare advancements. Midwives are medically trained and provide comprehensive care to pregnant individuals and their families, including prenatal care, labor and delivery support, and postpartum care. 

There has been a return to more holistic care for the birthing person and a collaboration of a more historically recognized practice of support and medical life-saving innovation. We’ve seen a rise in people using midwives (and doulas!), understanding the importance of whole-family and patient-centered care that doesn’t end when the child is born. 

Midwifery care, today.

The options and accessibility of delivery practitioners give today’s birthing person the choice to make the decision that is best for them and their needs. 

Midwives and other delivery practitioners, including obstetricians and family physicians, are integral to the birthing process, each with distinct approaches, training backgrounds, and areas of expertise. 

Midwives, specifically, are skilled professionals dedicated to supporting childbirth with minimal intervention. Their focus lies in personalized attention, consistent care, and enabling birthing individuals to participate in decision-making regarding their childbirth journey actively. Throughout pregnancy, labor, delivery, and the postpartum phase, midwives prioritize holistic support, addressing physical, emotional, and social aspects of the birthing experience. Midwives may work with patients in the hospital, or at home. 

Obstetricians (OB-GYN) are medical doctors who specialize in pregnancy and childbirth in hospital settings. They are trained to manage both low-risk and high-risk pregnancies, perform medical interventions such as cesarean sections and instrumental deliveries, and address complications that may arise during childbirth. 

Family doctors who provide maternity care can deliver babies too. For some, the continuation of care from a medical professional who has cared for the birther previously to becoming pregnant can be a reassuring choice. Not all family doctors provide perinatal care however, it depends on the doctor and the practice.

The other type of care is the MFM (Maternal Fetal Medicine) Clinic which provides care for complicated or high-risk pregnancies, this is only accessed as needed when referred by a healthcare professional.

Ultimately, the choice between midwives and other delivery practitioners depends on individual preferences, medical needs, and the level of risk associated with the pregnancy. 

Looking for vetted midwifery clinics in Lower Mainland and Vancouver Island?

ABOUT THE AUTHOR: 

Alicia Jerreat (she/her) is a writer and has spent the last ten years+ working with children as a nanny and a teaching assistant, as well as enjoying some doula training. Alicia has a passion for caring for and empowering families, child communication and development, breaking stigmas, relearning healthy patterns of childcare and holistic healthy living. She is currently also working on her debut fiction novel which focuses on sibling relationships and identity within families. Her writing website can be found here.

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