Certified Nurse-Midwives and Certified Midwives continue to be affected by historical myth.

Drama and Midwifery Imagery

After decades of effort by the American College of Nurse-Midwives (ACNM), Certified Nurse-Midwives and Certified Midwives continue to be adversely affected by historical myth and modern legend, which affect the public profiles of modern midwifery practice. Despite establishing a high-profile educational program, published professional practice standards and a scholarly journal, the ACNM has not succeeded in dispelling problematic historical and modern impressions of midwifery that prevail in medicine, nursing, law and society.

When surveyed, CNMs/CMs have indicated that the “attitudes and perceptions of medical and nursing communities present the most significant barriers affecting their profession, along with mis-perceptions of the public”. [1]

Trial Attorneys and the Execution of Midwifery Legitimacy

Trial lawyer advertising has also contributed to image problems. Reviewing the periodical and online advertisements of trial attorneys is instructive in regard to their motives. Warnings of the “dangers” of midwifery are a consistent theme. Some ads appear to support midwifery as a childbirth choice, while simultaneously warning consumers that if they must choose a midwife, efforts must be made to select one that has decent liability insurance. These advertisements appear to cause more fear and distrust in consumers than any alleged midwifery malpractice or mythical tale could accomplish. Anyone who searches online for “midwifery” will see plenty of them.

Bombarding consumers (and potential clients) with false and inflammatory information, attorney websites significantly contribute to negative consumer attitudes toward midwifery, further damaging the profile of the profession. [2]

Age Old Midwifery Nonsense

Although midwives have existed since female organisms began to swim, crawl, walk, and procreate, midwifery has evoked mystery, wonder, and the inherent powers of women. Not surprisingly, extreme and distracting characterizations of midwives have persisted through the ages.

Among persevering historical characterizations, midwives have been considered quaint, but also connected to the occult world. Midwives have also been historically linked with mysterious, medieval practices. Tales from antiquity describe witch-like crones, known to sequester in mossy huts on the fringes of forests and swamps; away from polite society. . . until they were needed.

Since ancient times, the perceived mysteries surrounding childbirth were regarded with varying amounts of suspicion and fear, particularly by men in awe of a powerful process existing, strictly, in the female domain.

Centuries of Legend and Myth

Like everything else, midwifery has evolved over time. Yet, centuries of legend and myth have left dramatic and enduring images which are completely at odds with modern practice. When questioned, most people describe a midwife as someone who delivers babies at home. Or in the back yard, in wading pools, and tree houses… Consistent with these impressions, the motives, legalities, and practice standards for modern midwives are rarely understood outside of the profession.

Historical tales are the most colorful. Limitless dramatic accounts have contributed to midwifery lore; tales featuring witchcraft, potions, hanging, burning, flying, and the devil. Not to mention, birth, death, and other disasters involving females.

Artem Maltsev Unsplash img
**Midwife casting a spell so all of the men in the village will disappear**.

Disturbing representations of midwifery remain popular. They are mainstream, predictable, and frequently ridiculous. Supporting the more popular and disturbing impressions are dramatic and unflattering portrayals of midwives presented in current entertainment media and popular fiction.

Unflattering Renditions of Midwives

With historical fiction, a midwife character may be portrayed as decrepit, toothless and weirdly dressed; a wild-eyed, eccentric female who practices Witchcraft, Magic, Voodoo or some version of scary spiritual practice. Without question, midwifery is magical, just not in these exaggerated contexts. [3]

Thematic Female Incompetence

When fictional media portrayals of modern midwifery are presented with a semblance of reality, the competence and independence of the midwife is usually diminished by a heroic male doctor who directly supervises her practice. The midwife character is featured as professionally lacking when compared to the wise and impressive physician. If the media production even identifies a character as a nurse-midwife, with the exception of making coffee, her competencies are confined to herbal remedies, psychic healing, or aromatherapy, euphemistic nods to her role as a “fringy” healthcare alternative. [4]

Historical Hysteria

Hyperbolic midwifery imagery runs the gamut from gnarled grannies scuttling through the back alleys of medieval Europe, to the drenched and weary assisting childbirth in the mud at Woodstock. Additional imagery has featured the midwife as a substance-dependent flower child, attending birth on the beach or in the attic of the Grateful Dead House. [5]

Where Would We Be Without Witchcraft?

Of course, some form of “witchery” is never far removed from discussions of the history of midwives and their “craft”. Accounts from medieval Europe and the early American colonies have generously contributed to the association between midwives and witchcraft. In the history of colonial America, exaggerated perceptions circulated of the magical powers of women, midwives, pets, and livestock; some of them extreme. [6]

Kayla Maurraise Fantasy Midwife unsplash-image

Shaded By Our Colleagues

It is unfortunate that fabricated accounts of midwifery practice prevail, and are disseminated from an unexpected source: the professions of nursing, medicine, public health, law, and from random healthcare providers that practice alongside modern nurse-midwives on a daily basis. Whether from professional jealousy, arrogance, ordinary disdain, or historical prejudice, colleagues in the delivery of maternity care have been free in expressing negative opinions and circulating unkind impressions of modern midwives.

Creative Punishment For Witchy Midwives

Obviously, the practice of midwifery has been historically over-burdened with nonsense, especially in regard to punishment. From early America, reliable historical accounts from the Salem trials have failed to verify that midwives/witches were ever actually “burned at the stake” for practicing their profession. Death by hanging from the branches of trees or crushed by piles of large rocks? Yeah. Set on fire? Not in America. As entertaining and dramatic as these images are, they persist in the shadows, often tainting any realistic understanding of modern midwifery.

Even now, practicing midwives, from differing educational backgrounds and philosophy, continue to suffer various forms of professional “punishment” due to distorted public and professional perceptions. Modern midwives continue to be unfairly judged, diminished, forced from practice, and prevented from achieving a professional status that they deserve.

The Less-Than-Professional Midwifery Workplace

Most Certified Nurse-Midwives in America, today, work within hospitals and hospital-run clinics which are physician-dominated. This derives from a long-standing medical hierarchy of healthcare in this country, and enhanced by the presence of “Nurse” in nurse-midwife.

unsplash-image **The modern scary outfit**

Although CNMs have good reason to be proud of their nursing backgrounds, the title has supported a perception that although nurse-midwives have obtained university post-graduate education and certified clinical expertise, they are rarely accepted within the hospital hierarchy as worthy or independent practitioners of maternal/infant healthcare.

These attitudes persist despite a well-defined scope of practice and joint statements of practice relations developed by the ACNM (American College of Nurse-Midwives) and ACOG (American College of Obstetricians and Gynecologists). In a hospital environment, nurse-midwives frequently lack baseline professional regard. They have been consistently denied enhanced clinical status or even moderate respect.

When Can The Mid-Level Designation Be Burned At The Stake?

To complement the already problematic profile of CNMs/CMs, there is a pervasive and heinous descriptor which has been attached to non-physician healthcare professionals practicing in corporate healthcare. Nurse-Midwives, Nurse Anesthetists, Nurse Practitioners, every nurse in an “expanded role”, including Physician Assistants (PA’s), must now contend with the unfortunate title of Mid-level Provider.

While witnessing their professional identities being diminished by this label, advanced practice clinicians, aka “mid-levels”, are being hired, en masse, by healthcare institutions for economic reasons. Despite being labeled as mediocre, advanced practice clinicians are being lured into care situations as physician-extenders or doctor substitutes. While economically advantageous for the hospitals, advanced practice providers (APPs) are not paid in proportion to their responsibilities, properly identified, or respected for their expertise. The mid-level designation is a stunning insult to independent clinicians who provide high-level care. See: “Mid-level Mortification”. ( http://www.midwivesontrial.com/articles/mid-level-mortification-n2yje-p3Akb-uYtmE)

Although still a persistent struggle, the practice of CNM/CM midwifery demands an understanding that it stands alone as a legitimate profession. To regard CNMs/CMs as mid-anything or an unsavory eruption from nursing, medicine, or black magic perpetuates confusion and distrust for an academically founded and relevant model of care. [7] [8]

References/Footnotes/Commentary

1. McCool, WF et al. Closed Claims Analysis of Medical Malpractice Lawsuits Involving Midwives: Lessons Learned Regarding Safe Practices and the Avoidance of Litigation. J Midwifery and Women’s Health. July/August 2015. 60(4):437-444.

2. Attorneys should consider how negative consumer attitudes might affect legal cases involving CNMs. With low consumer comprehension regarding the profession, it might be easy to convince a panel of jurors that midwives have no business as maternity health care professionals.

3. I concede the possible exception of the Call the Midwife series: BBC period drama about nurse-midwives working in the east End of London in the 1950’s and 1960’s.

4. Refer to seasons one and two of “Virgin River”: Netflix, adapted from the novels of Robyn Carr. In the Netflix series, the protagonist midwife began the first season as an independent Certified Nurse-Midwife who drives a red BMW, craves designer clothing and 400-thread-count sheets (these details suggest early mitigation for the anticipated negative “midwife” credential of this character). Abruptly, in following episodes, the midwife character is identified as a nurse-practitioner with an additional midwife “certificate” (like something she would have ordered online).

In Season One, the character did successfully manage an unexpected breech delivery in the middle of a hidden drug-ring encampment. But, by the second season, the presentation of the character as “midwife” was drastically toned-down and eventually eliminated. It is likely that the juxtaposition of her classy, cool and sophisticated character, and her identity as “midwife”, was just too incongruous for the production team. Apparently, it was better to lose the weird midwife identity and, instead, present her as an heroic, post-grad, “Nurse Practitioner”, ex-emergency room nurse at LA County, and former nursing supervisor of a war zone Emergency Department.

In the series, the character earns a fair amount of credibility with the resume of an Emergency Department nurse. As a midwife, they never gave her a chance. See also, Netflix production, “Pieces of a Woman”. This story, while beautifully done, pokes another finger into the eye of midwifery credibility. In the story, a home-birth midwife is held responsible for a newborn death and is sued for malpractice. The character is given a boring and depressed appearance and demeanor. She is also shown to panic during the respiratory arrest of the newborn she delivered. Yet another negative representation of professional midwifery.

Alvarro Sanchez **Grateful Dead House** Unsplash img

5. The counter-culture movement of the 1960’s was born in the Haight-Ashbury neighborhood of San Francisco. While this imagery might be suspect in describing a colorful era of midwifery, what is usually missing in media productions is a portrayal of midwifery that isn’t exaggerated or terrifying.

6. “In 1692, the Massachusetts Bay Colony executed 14 women, five men and two dogs for Witchcraft” . . . “No one burned at the stake.” “No midwives died.” From The Witches: Salem, 1692 by Stacy Schiff, copyright © 2015. Reprinted by permission of Little, Brown & Company, an imprint of Hachette Book Group, Inc.

7. Blumenreich, GA. “Nursing is not the ladies’ auxiliary of the practice of medicine”. AANA ANNUAL MEETING, Chicago. AANA Journal. June 2004. 72(3): p. 173.

8. Certified Nurse-Midwives (CNMs) are prominent in these articles. However, Certified Midwife (CM) educational requirements, qualifications for practice, care standards and legal liability burdens should be considered implicit in most discussions of CNMs.

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