Madwives, Medwives, and Midwives

Everybody knows what “midwives” are, even if some think that midwifery is a profession that ended with the Dark Ages (yes, I’ve actually seen at least one person express surprise that there are still midwives). But often on certain birth-related email lists, internet groups, blogs, etc., you’ll see the terms “madwife” and “medwife” in reference to midwives. What is a “madwife”? What is a “medwife?”

These terms are used in a pejorative sense to denote midwives who are — in the opinion of the person speaking or writing — either too quick or not quick enough to intervene medically. But since it’s an opinion, it is subject to a wide scope of interpretation.

Probably most of you are aware that I tend to be politically conservative, although I usually only bring up politics tangentially. I know that quite a large percentage of “birth junkies” tend to be liberal, and many are in my opinion very liberal. That’s fine — I’m not going to fall out with you, but I just won’t attend any political rallies with you. 🙂 In the past Presidential election, I and most everybody I personally know found John McCain to be too liberal, and either voted third-party, abstained from voting altogether, or “held our noses” and voted for McCain. For those of you “left of center”, you may be reading in disbelief that anybody thinks McCain is too liberal, since you found him to be suffocatingly conservative. I know that there are probably some people who felt the same way about Obama — that he was not liberal enough — and that is a little unbelievable to me, too.

Why bring up politics? Because it is an easy analogy to show the spectrum of opinion that exists in both governmental politics and the politics of birth. Just as there can be two widely different opinions about the same man when it comes to his political leanings, so there can be two widely different opinions about the same midwife when it comes to her level of intervention.

The Dr. Amys of this world would probably label any CPM as a “madwife”. I have seen her make the blanket statement that “DEMs [she refuses to call them CPMs] don’t check the fetal heartbeat often enough in home births”. Some people might call a midwife a “medwife” if she requires that fetal heart-tones are checked at least once or twice an hour. Same woman, same level of intervention, two different terms.

Being in various internet groups that promote home-birth and natural birth, I see midwives be labeled as “medwives” more frequently than “madwives”; but I’ve seen a few more medically-minded birth blogs or what-not that attract commenters who more frequently use the term “madwives” than “medwives.” It’s a lot of Monday-morning quarterbacking, to be sure, as well as just someone’s opinion. This means that it’s helpful to know where on the birth spectrum someone is, so that you can get a better idea of how they use the term “madwife” or “medwife.” If you are as conservative as I am, and (hypothetically speaking, and going back in time to before the election) you didn’t know anything about McCain or Obama, and I said something like, “McCain is too liberal!” then you may find that information beneficial and accurate; if you are a liberal, though, and you took my opinion as fact, you would be misled as to McCain’s political stance, because while I think he is too liberal, there are numerous other national political figures who are even more liberal than McCain, Barack Obama being one. If you voted based only on the information that “McCain is too liberal” (which is just my opinion, rather than a statement of comparison between him and Obama), you might choose as your Presidential candidate someone with whom you profoundly disagree — either because you voted for McCain because you thought he was as liberal as you when he was actually far too conservative for you, or because you voted for Obama because you thought if McCain is too liberal then Obama must be more conservative.

If you were to ask me about what kind of birth attendant to choose, you would get a completely different answer from the one you would get if you asked my sister. I prefer low or no interventions and home birth; my sister likes to have access to an epidural as soon as she walks in the door. Before you get my opinion as to how good a particular doctor or midwife is, it would be good to know for you to know where I am on the madwife-midwife-medwife scale, and it would be good for me to know where you are on that same spectrum. As long as our opinions coincide on the preferable level of interventions and desire for medical assistance, my opinion might be very valuable to you. If, however, you want the name of a good doctor who will schedule your C-section right now for a date some months in the future at 37 weeks gestation just because it fits into your schedule, you’ll need to find someone else to make that recommendation, because all of the people I would recommend do not have that practice style. In a similar fashion, if you want the name of a midwife who will just sit in another room while you are in labor and just be close but not enter into your space at all, I might not be able to help you because few midwives would be willing to do that (and many are legally required to have some level of interaction with you, such as listening to the fetal heart-rate at least a few times an hour).

Birth, like so many other areas, is in the eye of the beholder.