The Core of Midwifery
American College of Nurse Midwives
Hallmarks of Midwifery-The art and science of midwifery are characterized by the following hallmarks
E. Empowerment of women as partners in health care
K. Advocacy for informed choice, shared decision making, and the right to self-determination
Sometimes in your career you stumble across a truth that is so deep, so central to what you are doing, that it makes everything else become crystal clear. Empowerment of women as partners in health care, coupled with informed choice and the right to informed consent, was such a truth to me. Eighteen years ago, as a brand new Labor and Delivery RN, I had the privilege of working with a doctor who demonstrated the beautiful art of true empowerment and informed consent. I remember listening to her quickly summarize the risks and benefits of a proposed intervention, then sit back and quietly respect the woman’s right to make her choice, and I remember thinking, “WOW, so THIS is what they meant in nursing school! This is why I am here!”
Now, eighteen years later, I’m a certified nurse midwife, and advocacy for empowerment, informed choice, shared decision making, and the right to self determination are two of the hallmarks of my beautiful profession.
But what does this mean? There are no clear rights or wrongs in birth. No obvious choices that must be abided by, that all women MUST make. There are so many shades of gray, so many different paths to travel as families grow and birth their babies. We, as midwives, are here to support them through this, and to help provide them with the information to make the right choices for themselves and their families.
And this is an immense, critically important responsibility. Many birthing families come to us because they know we will respect their choices. They know what they want, and they believe we will support them in that. And we will, within the boundaries of our ethical obligations and our scope and regulations. However, this does not mean just listening to what the wants, and then giving it to them. This means always, without fail, discussing with a woman and her partner the risks and benefits of any proposed intervention, or deviation from standard of care. It means letting them know what our professional judgment is, as well as our regulations and legal obligations, and then letting them decide. Sometimes, because we are a low risk birth center, these decisions may risk a woman out of our care. This is one of the risks we must inform her of. But most often, it just means she is now aware of the possible implications of her choice. And this is what it is to be a human with body autonomy-you have a right to make the choice and then assume the responsibility of the consequences. And this goes for all decisions, large and small. As midwives we should not assume responsibility for our client’s choices. At the same time, they cannot be empowered, and assume responsibility, if we do not provide them with all the information.
Recently, I got in a conversation on a midwifery discussion board. Some were concerned that when we discuss seemingly small decisions, like whether or not to have an IV in labor (many were hospital midwives where an IV may be standard), or what a woman would like to wear during labor, we are bothering people with minutiae that make the process more difficult. I hold that we MUST bother people with this minutiae, as it is these decisions, large and small, that make them the responsible party, and that empower them with bodily autonomy.
It is not that we have to leave people hanging to make these decisions without any information. It is that we have to provide them with the information we have that is pertinent to making decisions about the situation.
I work with so many amazing providers, both in hospital and out, that provide this level of empowerment and informed consent. It is hard, it takes time, and often people feel you are trying to scare them into decisions when you present risks and benefits fully. As a provider, I have found that often small things, when done at times of vulnerability, affect others in big ways. I try to consider this carefully when providing care.
I believe THIS is the core of midwifery. This is the very base, core level of empowerment and informed consent. That all decisions matter. None are too small, from wearing a gown, to eating during labor, to an IV. That all choices are theirs, not ours, to make. THIS should be the core of nursing, of midwifery, and really of all healthcare.
I feel so blessed to have witnessed this and all that implied at the beginning of my career, and I hope that I come even close to providing the clear, unbiased information that I witnessed in awe so many years ago.
In faith and love,
American College of Nurse Midwives , Core competencies for basic midwifery practice, http://www.midwife.org/ACNM/files/ACNMLibraryData/UPLOADFILENAME/000000000050/Core%20Comptencies%20Dec%202012.pdf