Pregnant Woman Portrait photo taken by Anna Kosali. Model: Yuliana Eylül
The term medwife is a relatively new term describing someone who, by training, is qualified as a midwife. They can legally refer to their work as midwifery, but by practice they are something quite different. There are no hard and fast rules but who employs her is often a good starting point. Will you personally employ her or is she employed by someone else? However there’s more to it that that so without further ado:
Here’s some questions to ask any midwife to help you determine who you are dealing with.
1. Do you recommend any routine testing in pregnancy? A midwife will offer testing, based on risk factors, when the results may alter the choices for pregnancy and birth. A medwife will recommend routine testing regardless of risk factors and regardless of the effectiveness of the testing (including but not limited to GBS swabbing, and GD testing).
2. How do you assess progress during labour? A midwife will watch your behaviour, she might talk about knowing where a birth is at by the smell in the room (yes really!) or the sounds you are making. She will recommend a vaginal exam to test for dilation in the unlikely event that it will give information that may alter choices but the majority of the births she attends will never have a vaginal exam. A medwife will do vaginal exams routinely.
3. What if labour is progressing slowly? A medwife will have a certain time in which they need labour to conclude, they may offer drugs to reach that limit. A midwife will recommend food, water, rest, maybe some movement. She will want you to be healthy rather than to give birth in a certain time frame.
Listening to baby with a midwife - Image Courtesy of Wikimedia Commons
4. How do you feel about breech birth? A medwife will recommend surgery, listing the risks of bottom first babies.. A midwife will offer you facts and figures, the risks and benefits to both birthing and having surgery for breech. She will make recommendations but give you decisional power.
5. How do you view VBAC / VBAMC? A midwife will offer a balanced view of both options. A medwife will give you more information about the risks of birth.
6. When would you recommend induction? A medwife will give you a date by which you must give birth, be induced or transfer care to a surgeon. A midwife will say that her recommendations are to remain pregnant unless there is some health factor that requires action.
Midwifery is far easier to access outside of a hospital. Hospitals don’t hire midwives who won’t dot all the Is and cross all the Ts. A true midwife who doesn’t induce, never performs routine vaginal exams in labour, prefers women to drink water than have IV fluids, isn’t concerned by gestation or length of labour when women and babies are healthy, would be fired from a hospital for not practicing by their protocols.
No one would suggest that all the midwives who work in hospitals are medwives, just that their employer has tight controls over the way they serve women, and that it’s impossible to maintain your job in a hospital without doing what is required of you. Many wonderful, kind compassionate women work as midwives in an institutional birth setting, and conversely many medwives work outside of the system practicing medwifery under the guise of midwifery. So be wary when you are looking for a care provider, and remember that often the first giveaway sign midwifery vs medwifery is who pays for the services.