Sustainable Midwifery

Abstract

Sustainable midwifery is best realized in a model of care that promotes not only optimal health for women and families but also long-term well-being for care providers. Midwifery has been with us since the dawn of our existence, but in numerous industrialized nations and despite excellent outcomes, midwives have been marginalized by political oppression based primarily on desires for the power and revenues of childbirth. As articulated by Davis-Floyd (Davis-Floyd, Int J Gynecol Obstet 75(Suppl 1):S5–S23, 2001; Davis-Floyd, American midwifery: a brief anthropological overview. In: Davis-Floyd R, Colleagues (eds) Ways of knowing about birth: mothers, midwives, medicine, and birth activism. Waveland, Long Grove, pp 165–188, 2018b), the three models of healthcare now practiced are the technocratic, humanistic, and holistic. Each of these has a role to play in the perinatal period, but in terms of sustainability, holistic care is far superior, as within it, the patient becomes a client and primary decision-maker in her healthcare experience, with the midwife an equal partner in their interaction. The hierarchy that characterizes technocratic care, with practitioner in charge and patient essentially powerless, dissolves in holism. Medical education for hospital practice is largely based on technocratic tenets of authority and control, humanistic education may add elements of communication and kindness, but holistic education is the game changer. Tenets of holism can be used in any setting, as the time-tested skills of midwifery care are increasingly articulated and refined to meet a rising demand for this type of care.