What are Core Midwifery Skills? Recently, I was asked by the Editors of Midwifery Today magazine to share my thoughts on this question. Here is my answer.
When I hear this question my mind goes to two worlds; one space focuses on the Art of midwifery and the other focuses on the Science of Midwifery. Both places are necessary, both have their own strengths as well as their own weaknesses. Science can become too cold and clinical while Art can become too soft and lacking in substance. In my humble opinion, it is critical to have a solid foundation in both worlds to practice quality midwifery and honor our clients with excellent care. Traditionally, midwives have been adept at weaving together these threads. In our current culture, however, I have noticed some groups that eschew one over the other and seem to believe that they are both not needed. When embracing this path, it is critical and owed to our clients, that we walk both lines and become proficient in both the Art and the Science of Midwifery.
Our human bodies represent the most complicated and technologically advanced tool ever created. All of our human endeavors pale by comparison. For the most part, when well cared for, our bodies are excellent at taking care of themselves and require little assistance from external sources. This is especially true with pregnancy, over the eons our bodies have been fine-tuned and adapted to the work of sustaining and then birthing our children. The very survival of our species is dependent on this task and so we must do it well. When a body, that has been healthy, conceives a pregnancy it will most likely remain healthy through the process. However, there can be deviations and this must be acknowledged. Some pregnant folks and some babies will need intervention to remain healthy and well. For these clients, we as midwives must be able to observe and recognize the early signs of these potential deviations. We must be able to respond to the early warning signs in the appropriate manner before they become more serious.
Let’s look at this issue through the lens of one potential deviation; anemia. Blood is the living water of our bodies, we cannot survive if our blood is not healthy. In order to grow a healthy baby, our blood must be rich and well nourished. As a midwife, it is my responsibility to understand and have knowledge about how blood functions and moves through the body. I must be able to analyze and interpret laboratory findings that look at blood. I need to know the mechanism of anemia and how it is diagnosed clinically, as well as the various types of anemia and how to differentiate them. This is crucial as the treatments vary depending on the type. Many cases of anemia are best treated through nutritional support and dietary interventions, however, some cases will need more intervention ranging from herbal treatments to IV infusions of medication. It is critical for me to recognize the difference and educate my families on their options.
Having a strong foundation in biology, chemistry, anatomy & physiology, embryology and immunology are essential skills for any midwife. These areas represent the Science of our profession and should be respected and honored. As the foundation, it is my opinion that these areas should be well studied at the onset of training, with this solid footing we can move forward to learning the Art of our profession.
It’s like anything else in life, you must first learn the basics. Because, let’s be clear, the Science is only the beginning. After absorbing it, the true work can begin. The work of learning the true heart at the core of midwifery skills; to be with woman. Midwifery has a history of meeting the pregnant family where they are, of working to support them in the ways that best suit the individual. This is an Art, this listening, being open and observing. These are our most valuable skills and where we synthesize all the information and observations to look at the whole picture.
In order to tap into this Art, we must learn to use all of our senses. Of course, with our ears we listen; to all the subtle cues, the words spoken and the words unspoken, the sounds of the birth song, the lub-dub of the beating heart, the whooshing of air through the lungs, the cry of the newborn and the sounds of swallowing at the breast. With our eyes we observe; the steadiness of the gait, the rise and fall of the chest, how the new parent holds their little one, the swelling of the breasts with milk. Our hands absorb information through touch; the squishy movements within the womb, the normal warmth of skin versus the heat of a fever, the position of the baby, the pulse of life in the umbilical cord after birth, the firmness of the womb as in involutes. Through these senses we also give feedback and support to our clients; our voices educate and empower, our touch offers reassurance and strength, our eyes meet theirs in the moments of joy and heartbreak. Through our senses we learn to hold and provide the sacred space needed by each family on their journey.
Lest you think that is all, let’s not forget one last crucial core skill; self-care. This one may be the hardest to master. In order to provide competent, quality care to our clients we must be healthy and whole ourselves. We must be rested, we must have laughter and activities that bring us joy, we must move our bodies regularly, spend quality time as well as regular old day to day time with our own families and spend time not being a midwife. We must use our senses on ourselves and check in to make sure we are doing these activities and keeping our own bodies well.
Once we have become adept at using our senses, we can circle back around to the science, sprinkle in the self-care and tie it all together. In this space we truly practice all that midwifery encompasses. We have found the Heart at the Core and can walk alongside our families on the crazy, wild and beautiful journey of life.
Image credit Aubre Tompkins, CNM