Sojourn Magazine, Summer 1999, Volume 3, Issue 3 

The Midwifery Model of Care by Betty Idarius 
Although I've been a practicing midwife for over twenty years, my entry into midwifery was not intentional. In the early 1970s I was invited to attend the births of a few friends. Then more friends became pregnant and asked me to be their midwife. It was common for women to have their babies at home at that time. Pretty soon I had more experience than anyone else in the area. I realized I needed to learn more, so I began studying and training with a female M.D. who ran a childbirth clinic in the town two hours from where I lived in rural British Columbia. 

In 1981 I attended the fifth water birth in the United States. It was for a couple who were part of the rebirthing community in San Francisco. Rebirthing is a breathing technique that is used to help resolve traumas that can happen during birth. This couple wanted the gentlest birth experience they could create for themselves and their baby. 
     A filmmaker was invited to film the birth for the couple. There was a TV screen set up in the next room, where their friends could watch. Waterbirth was new, and I wasn't sure about it.  A pediatrician was there as well; we both decided we would do the birth if the other one of us stayed. Everyone ended up in the birthing room. We were all profoundly affected--seeing a woman laboring in water totally relaxed and open, with no tension whatsoever, saying positive affirmations as she delivered her baby. There was so much love. 
     After her head was born, the baby opened her eyes, looked around and connected with everyone. She was born to her waist, and then slowly and gently came out into the water. The dad supported her underwater while I monitored her heart rate. Once I saw a relaxation response and felt she was fully in her body, she was gently brought up to her mother's arms to take her first breath. That took just ten to fifteen seconds--not a long time. 
     Karil, the filmmaker, was so inspired by the experience that she decided to go to France to film Michele Odent, a doctor who was doing lots of water births at a center outside of Paris. Then she went to Russia and filmed Igor Charkovsky, who had started doing water births back in the 1970s when his daughter was born prematurely. Although he was told that she had no chance of surviving, he was inspired to put her in a tub of warm water. She was there for twenty-four hours a day, and thrived. He found that if the body doesn't have to deal with gravity--and gravity is a form of stress--then it is better able to heal itself. 
    Over a five year period, Karil created the documentary: "Water Baby: Experiences of Water Birth." It starts with the water birth in San Francisco and includes footage of Michele Odent, Igor Charkovsky and Michael Rosenthal. Rosenthal had a water-birth center just outside of LA. He has attended thousands of water births, and has gathered statistics to show their safety for both moms and babies. 
     A tub of warm water is an ideal place for a laboring woman. It helps her to relax and tune into her instincts. It is very effective for pain control. The more relaxed a woman is during her labor, the more her hormones and endorphins can flow, allowing the birth to progress naturally. It is very difficult to be tense when you are floating in warm water! 

For about five years I stopped practicing midwifery, after realizing that I was infertile. This discovery was incredibly traumatic and painful for me. I tried to become pregnant using in vitro fertilization (IVF)--without success. 
     The door that opened for us to have our family was through open adoption. We were blessed with the arrival of a beautiful baby boy, Benjamin Raphael, whom we adopted at birth. I was able to nurse Benjamin and produced about seventy percent of the milk he needed. The rest was donated breast milk given to him via a supplemental nursing system. Later we switched to goat's milk, to which I added nutritional supplements according to a naturopath's recipe. 
     One day I received a call from a pregnant woman who wanted to have a waterbirth. I was the only midwife in the area with waterbirth experience, though I had only attended seven or so at the time. Another midwife was willing to facilitate the birth if I would assist. It turned out that this midwife was in a car accident and couldn't use one arm--and she had three women due within the next week. She begged me to come and help her, so I agreed. Once again I was drawn back into midwifery. 

In 1988, I challenged the Arizona midwifery licensing program, and passed the state exam, becoming the first midwife in Arizona who was licensed through apprenticeship. My family and I moved back to California in 1991. After the Licensed Midwifery Practice Act was passed here in 1993, a challenge process was also developed. This means that both nurse-midwives and licensed midwives can now legally attend home and hospital births in California. The difference is that certified nurse-midwives are nurses first, who then go through a midwifery program, whereas licensed midwives learn only midwifery. I passed the California challenge process in 1997, becoming number sixty-four in the state. 
     From the beginning of time, women have been supporting other women in birthing . The traditional midwife safeguards the natural process of pregnancy, labor, and birth. Midwifery is an art--taught woman-to-woman--the art of empowering women. We help women to trust in themselves and their ability to be a channel for life. 
     Obstetrics has only been around for 100 years or so. We often think that birth was made safer when it was moved to the hospital, but this isn't true. Safety is a result of improved hygiene, economic status, nutrition and access to prenatal care, not a result of hospitalization. In fact, the move to the hospital created more life-threatening infections for birthing women until doctors learned to use chemicals to clean their hands and instruments. 

As a midwife I want to establish a relationship of trust with the pregnant woman. It is important to get to know her intimately: How is her relationship with her partner? How is her home situation? What is her emotional make-up? How does she deal with stress and with pain? Everything in her life becomes a factor in how she will give birth. Those are all things that a midwife looks at. 
     Whatever tension she has in her life will affect her ability to give birth, and needs to be dealt with. If she needs more emotional support, I may suggest that she seek counseling. It is important for her to safely give voice to feelings that come up around birth. A pregnant woman needs someone to listen to her, to tell her that she is doing fine, and to help her find her resources. She needs to be encouraged to reach out to her family and friends for support. 
     I spend two hours at a first prenatal visit. We go through everything in great detail, including nutrition. Nutrition is the number-one gift a mom can give her unborn, so I give it the time it deserves. I schedule an hour for each follow-up prenatal. That's a long time to spend, but I feel that it's important. I encourage dads to come, and the kids. The whole family is involved. 
     Most of us  did not see babies being born as we were growing up; we didn't have an opportunity to see what normal, natural birth is like so that we could trust the wisdom of the body. Children are usually removed from witnessing birth, death and even illness. Natural events that could be part of their lives become mysterious and secret medical events. What we see instead, in movies and television, are frightening images of birthing women totally out of control. These need to be replaced with healthier images. 

In childbirth, I often see women replay their own births--generally subconsciously. It is helpful for women to find out what happened when their mothers birthed them, and to heal unresolved issues from past abortions, infertility, or difficulties giving birth. In this way,  giving birth won't bring up so much fear from past pain. 
    The infant's nervous system is totally open at birth; the birth imprint affects them physically, emotionally and mentally. Whether gentle or traumatic, birth is like a flavor that carries forward, leaving an impression of what being alive and being in the world is like. 
      Birth is a sacred event. It is the time when spirit--not just the body--comes into manifestation. Like death, it is a huge, deep, profound transition. If birth is not approached as sacred, the baby will feel, "What is going on here? Why am I not being honored for who I am as a spiritual being?" A non-sacred approach to birth causes confusion and trauma for that incoming spirit. Being born and having the opportunity to live, learn, give of ourselves, and connect with other people is a gift to be honored from the very beginning. 
     Indigenous cultures know and recognize the sacredness of birth, but our culture tends to approach it as a technological event. If the baby and the mother are alive and not sick, then that's considered a successful birth. Well, it's not! It's just a beginning. A much deeper perspective is necessary to heal the split we've created between the body and spirit. 
Because many women have to focus on basic survival needs, they don't get into the spiritual reality of birth. This is a tragedy. The child that is coming forth is a gift for everyone, not just "another mouth to feed." The entire community needs to rally around the pregnant woman, so she doesn't experience a sense of isolation. 

A doula is an advocate for the birthing woman. Doula means "mothering the mother." She is there during labor, birth and also postpartum. Research studies show that women who have doulas present are able to handle the pain of labor more successfully, and their ability to have natural, vaginal deliveries is much greater. 
     Our ancient wisdom needs to be brought back into modern birth practices. During labor, a woman's instinctual self knows what to do--how to breathe, how to move and how to birth her baby. Midwife means with woman photo courtesy of Deb Phillips, Midwife, NLR, ARWhen we direct a birthing woman too much, we give her the message that knowledge of her body is outside of herself. For her to access her intuitive instincts, she needs a natural environment--low lights, quiet atmosphere, non-intrusiveness-- allowing her and her supporter(s) to have a sense of privacy and co-empowerment. As a midwife, I remind myself to stay out of the picture (while monitoring for problems) as much as possible. I hold the space of knowing that the mother already knows how to give birth. Some women want me to be actively involved, but many don't need that. 
     Birth is a very intimate experience--a sensual/sexual experience. A birthing woman is luscious, full and ripe. She needs to be given privacy and respect so she can get in touch with her birth energy. It's so easy to interrupt, disrupt and interfere. If the sacred space is intact during labor and birth, then she will be strong and beautiful in her birth work, even when it is difficult. 
    During labor and birth, a woman is very sensitive to changes in her environment. In the hospital, it's disruptive when one nurse's shift ends and a new one comes on duty. The doula and/or midwife, maintains continuity by staying with a woman throughout her labor and birth. 

I ask the women I work with about their dreams, because dreams are a strong indicator of their unconscious feelings and thoughts. If a pregnant woman has frightening dreams about her baby, talking about them helps her to deal with those fears. Acknowledging the fear is often all she needs to do to release it. Sharing joyful dreams gives her the opportunity to express the magic of her unconscious, intuitive side. Dreams are a powerful avenue for doing the healing inner work that needs to be done. As healing progresses, this is reflected in the dream life. 
     Some people approach dreams by trying to understand the meaning of symbols, but symbols are different for different people.  For me, the feeling in the dream is what is most important. This approach provides a simple way to access what a dream is about. 

People wonder why childbirth has to be painful. It's an interesting question. Why couldn't God/Goddess have made the pelvis one centimeter bigger to make things easier? I feel that the pain of childbirth forces a woman to surrender to something higher than herself. You can't give birth while you are in control. It's impossible. So a woman has to surrender, surrender, surrender. The hormones flow; the endorphins come in, life comes through. That incredibly beautiful experience is the reward. 
     Giving birth teaches humility, patience, surrender and perseverance. Through selflessness, a woman experiences true giving. Birth demands being totally present with each moment. If she starts worrying about the next moment she will surely "lose it." So the pain of childbirth forces her to experience many spiritual truths directly--making a woman a great mother, a strong mother. This gift of wisdom only comes when she is allowed to give birth from inside of herself. 
     Trying to make sense of my own infertility, I asked myself, "Why should I have to go through this as a midwife? Here I am, serving other women who are having this great experience that I am not allowed to have." For whatever reason, infertility has been my avenue for birth and surrender. I couldn't control my ability to become pregnant. I had to surrender, trust, and learn that in humility. The same spiritual lessons of childbirth are available to us in whatever experience life brings us--poverty, illness, wealth. Life's truth and wisdom transcends the small perspective of our ego. 

The Native Americans say that the mother-child is the first environment. If we don't honor that first environment as sacred, then the family becomes ill, becomes diseased. Then the community becomes diseased; the environment and the whole planet become diseased. A culture that does not honor the primary unit will have problems--major problems. 
     A child is born complete: an individual with its own thoughts, beliefs and feelings. When an adult treats a child as if he or she is nothing, the child feels stifled. How can this child grow up with self-respect? In my experience as a child, when I voiced my thoughts I was often told, "Oh no! You are just a child. What do you know?" The truth is that children often see things more clearly than adults who are shut down to their own beauty and knowing. 
     After birth, when a baby cries, a person may think, "Isn't that great? She is opening up her lungs." But even in crying, babies are communicating to us. We need to listen to children, and hear what they have to say. We say "no" to children's spirits by considering their thoughts or feelings as silly or childish. This causes children to distrust themselves. If children are forced to go outside their inner knowing to find what is real, it creates a kind of schizophrenia--anxiety, neurosis, all types of disease and illness. If we see and encourage the innate goodness in them, children will live their lives from that place of goodness. 

In the hospital a woman's body is treated like a machine. She is hooked up to other machines that evaluate her body's function or malfunction. An IV becomes the umbilical cord attaching her to the hospital--to regulate her labor with pitocin, or to hydrate her because she isn't allowed to eat and drink anything. Although IV's aren't routine, too many women end up with them. 
     Continuous fetal heart monitors are routine and inhibit a woman's ability to move freely. If the baby is doing OK, the mother is monitored fifteen minutes each hour. Nurses can monitor Preparations, photo by Liz Haapanena whole ward from the nurse's station. Crazy! As everyone watches machines, the focus is removed from the woman's own knowing, and her trust in her body's wisdom. 
     Here in the United States, where ninety-five percent of births are attended by physicians in hospitals, we spend the most money on maternity care per capita and use more technology than any other country. Yet out of twenty-five industrialized nations, the US ranks 3rd from the bottom in safety for babies living through the first month of life. What does this teach us? One intervention typically leads to another, and this cascade of technology puts the mother and baby at risk. Seventy percent of US hospital deliveries are instrument assisted--either forceps, vacuum extraction, or cesarean section. 
     In developed countries that have the best outcomes for mothers and babies, seventy percent of births are attended by midwives. Worldwide, midwives attend eighty percent of all births. 
     Contrary to what most people believe, statistics consistently show that midwife attended births and homebirths  are as safe or safer than doctor-attended hospital births. Homebirth only becomes dangerous when doctors and hospitals refuse to provide backup care. 
    Obstetricians are trained to look for and manage complications. Their job is important in high-risk situations, but this  small minority can usually be screened during pregnancy and/or delivery. During normal births OBs tend to intervene unnecessarily. 
    "Active management of childbirth" means regulating a woman's labor with pitocin, a synthetic hormone, according to a preset schedule, (Friedman's curve), not her internal rhythm. Pitocin induced contractions are much more painful and difficult to manage than natural ones--making a woman much more likely to need pain medication, which leads to further complications. 
     Obstetricians do episiotomies on about sixty percent of all women and ninety percent of first-time moms. A midwife helps a woman to prepare for birth so that she will not tear. She works with breathing, provides perineal support, and uses warm cloths and oil on the mom's bottom. 
     In hospital births, women are often given pain medications such as Demerol or epidurals. At least fifty-percent deliver with epidural anesthesia. Women aren't told about the adverse and dangerous effects of these drugs--such as lengthening labor, lowering blood pressure, causing fetal distress, making pushing ineffective, and causing breathing problems for the infant after birth. A medicated woman is much more likely to end up with a forceps delivery, vacuum extraction, or cesarean birth. 
    Drugs are considered normal during birth. Yet, if a woman were to use drugs, smoke or drink alcohol during her pregnancy, she would be criticized. Any woman in heavy labor or transition will think that she can't deal with the pain. She will want help. That's natural. But if she has prepared for the birth and has the support she needs, she'll know that transition doesn't last very long and that she can most likely manage without medication. 
     Drugs also interfere with the instinct of bonding, and create a tendency toward depression, anxiety, drug addiction, and violence. A Swedish study published in the British Medical Journal in 1998 showed that individuals who committed violent suicides were subjected to about twice as many interventions at birth than their siblings. They were also more prone to depression, substance abuse, and schizophrenia. 
     There are many reasons to re-evaluate our approach to childbirth, and for giving women more information to help them make informed choices. I used to think that double-blind studies and statistics would change medical practices. In spite of the many studies proving that the midwifery approach to childbirth is safer than the medical approach, the bias against midwives persists. 
     I sympathize with the predicament of the obstetrical profession. Our cultural conditioning to expect perfect outcomes from every birth is unrealistic. It forces doctors to pay ridiculous premiums for liability insurance and to perform procedures just to protect themselves legally. But death and illness are natural to life. 
     The evidence is clear that professional midwives should be the care providers during normal pregnancy, birth and postpartum. When medical intervention is indicated, the midwife would consult or transfer care to an obstetrician. This system, recommended by the World Health Organization, makes the best use of the expertise of both professions. The result would be less medical intervention, fewer cesareans, better maternal-infant outcomes--at a savings to our health care system of  thirteen to twenty billion dollars per year. 

As a midwife supporting natural childbirth, I wanted to find a system of medicine in alignment with the laws of nature. I began to study homeopathy, and eventually became a certified homeopath. Homeopathy rebalances a person's immune system so that they can heal naturally. Since homeopathy addresses inherited patterns of health and disease, the ideal time to get homeopathic treatment is prior to conception. The healthier the parents are, the healthier their child will be. However, homeopathy can be safely and effectively used at any time during pregnancy and birth. 
     Homeopathy is a complete system of medicine and is widely used throughout the world. At the turn of the century, about 100 medical schools in the U.S. taught homeopathy, and there were about about twenty-two homeopathic hospitals. However, due to the competitiveness of allopathic medicine, funding was Betty and her son, Benjamin.  Photo by J. Idariuswithdrawn from homeopathic institutions and doctors were forbidden to practice or consult with homeopaths. This was not the case in other parts of the world. 
     My book, The Homeopathic Childbirth Manual, teaches childbirth professionals (whether beginning or experienced homeopaths) how to use specific remedies. During birth, homeopathy can prevent hemorrhaging, help expel the placenta, start labor, turn a breech or posterior baby, ease a woman's sensitivity to pain, prevent or heal tearing, episiotomy or caesarean section. The list goes on. In newborns, it can be used for shock, birth trauma and breathing problems, and later for colic, teething pain and infections, etc.

 Cover Artist: Kay Curtis ~ From the Editor ~ Infant Massage  
Introductory Notes on Bonding & The Perinatal Life 
Midwifery Model of Care ~ The Seasons of Life 


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