Being Pregnant
Does the Midwife Brand Need a Makeover?
Midwives deliver babies in hospitals. Midwives prescribe medicine. Midwives order ultrasounds, prenatal tests and blood work. Midwives are not the same as doulas, who are trained birth assistants. Midwives are covered by many insurance plans.*
Did you know all of that?
I’m not sure I did when I became pregnant with my first, some seven years ago. Like many other Americans, I assumed that midwives were not really a part of the mainstream maternity care system.
I had no idea, for example, that my insurance would not only pay for a midwife in New York State, but also the entire cost of a midwife-attended home birth if I were to go that route. People are shocked when I tell them I paid nothing out of pocket for midwifery care.
And so it was with great pleasure that I read “Cultural Misconceptions and the ‘Midwife’ Brand” over at, of all places, Fast Company, a business magazine. The piece is written by Sam Ford, a strategist for a communications company — an unlikely source for what I consider to be a hugely important argument: The midwife “brand” needs a boost.
“I think there’s a major disconnect from a branding and marketing perspective with what I would consider a key professional role in the world: the midwife,” Ford says.
Ford writes that he became interested in the midwifery “brand” when he and his wife “accidentally” found themselves under midwifery care through an insurance company referral. He had assumed doctors were the only ones safely and/or legitimately delivering babies. But then he and his wife loved the care they were getting and stayed on, despite “concern” on the part of their friends and family. His wife’s post-date pregnancy was induced on the recommendation of their midwife. They delivered in a hospital. The midwife continually encouraged them to keep an open mind about birth, including the possibility of necessary medical procedures. And she was with them the whole time, giving support and easing their anxieties.
It’s really a wonderful piece and I recommend reading it in its entirety. But I want to quote from the conclusion:
“Many are battling these extreme [incorrect] notions of what a midwife is or does. Advocacy groups for midwives are quite active, and the rise of young mother movements amidst the growing influence of mommy blogger communities have given voice to pushing back against a culture of cesarean sections, of excessive use of medical intervention, etc. But, to me, the battle will not be won until midwives can be positioned not as some new fringe “hippie-mother” movement but as a longstanding and natural part of the human experience, as part of rather than a threat to the modern health care industry.”
I actually don’t really have a problem with “fringe, hippie-mothers.” In fact, some of the older, crunchier women I’ve met in the childbirth community in New York are completely brilliant and not a little badass. But I think his point is really interesting and important.
As a culture, we tend to see only the extremes. We love a good, clear fight, even at the expense of facts. When it comes to birth, there are “the crunchies” and there are “the medicalized maniacs.” But the extremes don’t tell the kind of stories I hear all the time. And that Ford tell us about in his thoughtful piece.
It’s fascinating to think of the “brand” of the midwife purely from a communications/PR point of view. Maybe some innovative, stylish re-branding campaigns could help the midwifery image. (A blockbuster summer movie about a life-giving, luminous midwife played by Julia Roberts?)
But I also think the legal environment could have a big impact. New York state recently improved conditions for midwives, but there are still parts of America where midwives are not welcome. In other countries, where midwives are in charge of most births and doctors only come in if there’s the need for a C-section, the midwifery brand is doing just fine. So maybe if midwifery was more widely supported by hospitals and state governments, we’d see a boost to the public image. (I’d still like to see that Julia Roberts movie though.)
You can read more about midwives here.
*Not all midwives are licensed to practice in hospitals or prescribe medicines; the list here mostly applies to certified nurse midwives or certified midwives. A small subsection of midwives, “lay midwives,” are self-trained and practice outside of the system. Laws about the practices of certified midwives vary by state. Some states are much more pro-midwife than others.
photo: “Parkland Midwives” by Erling A/Flickr
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Sam Ford commented on Oct 16 10 at 11:23 amMy wife and I really enjoyed your piece, Ceridwen, and I’m glad that you found some value in the piece I wrote for Fast Company. Definitely off the beaten path of what Fast Company usually covers, but I do think there are some marketing lessons to be learned for what I consider to be a really unfortunate problem. I’m with you: I know some “hippie-moms” who have been of great help to Amanda and me, who have offered a lot of support, etc. But I believe we can all agree that it’s really unfortunate that midwifery is now seen as the fringe, and I do think it contributes to the C-section culture we find ourselves in. Anyway, really wanted to say thanks for the thoughtful response to my piece, and I’m glad you found it accurate, considering your expertise.
Susan Jenkins commented on Oct 16 10 at 4:57 pmHi Ceridwen and Sam,
I’m a member of the Steering Committee of the Big Push for Midwives Campaign. We are a coalition of state consumer groups and midwifery organizations who are working to change the laws in the 23 states, D.C., Puerto Rico and, yes, Guam, where Certified Professional Midwives are not licensed or regulated to practice legally. Certified Professional Midwives (CPMs) are midwives who are specifically educated and certified to provide midwifery care for out-of-hospital birth, either in freestanding birth centers or in their clients’ homes. CPMs are certified by the North American College of Midwives, which is nationally-recognized by the same accrediting entity that recognizes the credentialing body for certified nurse-midwives and certified midwives. CNMs and CMs, in contrast to CPMs, primarily (about 97%) attend deliveries in hospitals and receive most of their education in the hospital setting. We totally agree with you, Sam, that midwives need to brand themselves better and get the word out to the public about the high quality of the services they provide and the high degree of client satisfaction with midwifery care.
Ceridwen, this is a great blogsite you all have here (we already know and love Danielle!) and your book From the Hips looks like something we’d enjoy reading and sharing with all the folks who visit our website. Shall we do some linking? Here’s the link to our website: http://www.thebigpushformidwives.org/
CPMs come in all shapes, lifestyles, backgrounds, interests. Some may be a bit hippie or crunchy, but many others are urban and hip, suburban soccer-mom types, and some come to midwifery from a religious background. Politically and culturally, midwives are across the spectrum. The word “midwife” means “with women” in old English, and every woman in American can find a midwife who is the right “fit” for her.
Kayt commented on Oct 16 10 at 7:43 pmWhen I was pregnant, I assumed I would see an OB. And I did, for most of my first trimester. I hated that OB and switched practices. By sheer luck, I saw a midwife who was associated with the OB-GYN group I went to. I loved my midwife. She was simply the best! When it’s time for number two, I’m going straight to her. I also liked how she had standing orders at the hospital I delivered at, and since I was seeing her, she promised she would be there. If I had seen an OB, I would have gotten whoever was oncall.
ceridwen commented on Oct 17 10 at 10:58 amThese comments make me very happy: Sam, I really enjoyed your piece– it got me thinking. And I’m a big fan of The Big Push for midwives. I love this: “CPMs come in all shapes, lifestyles, backgrounds, interests. Some may be a bit hippie or crunchy, but many others are urban and hip, suburban soccer-mom types, and some come to midwifery from a religious background.” It’s so true and the same would go for obstetricians, too. Writing this blog is most meaningful to me when I can be a part of opening up conversations rather than closing them down.
Melissa commented on Oct 18 10 at 11:04 amI work on the communications team at the American College of Nurse-Midwives (we represent CNMs and CMs). I’m so glad to have found this piece. I’ll be sharing this post and the Fast Company article with the rest of my team. This is an issue on which we are constantly working.
Melissa commented on Oct 18 10 at 11:13 amAnother thought–one thing that makes midwifery so difficult to brand is that midwives come in all “shapes, lifestyles, backgrounds, and interests.”
ceridwen commented on Oct 18 10 at 11:19 amMelissa– You’re right, that does make it hard. It’s such an interesting question. Also, there’s been an ongoing struggle in the history of midwives about this, no? The problem being that if you go so far into the “we’re medical professionals, too!” territory is there a devaluing of the midwifery model which is significantly different from the medical model of care? One thing I do in my writing and teaching is to always say, “your midwife or doctor” just to put it out there constantly that these are both “normal” and appropriate choices. But it upsets me that people don’t realize the considerable skills a midwife brings to the birth. Skills that are so valuable to women in labor and not really available from people other than midwives.
Melissa commented on Oct 18 10 at 4:38 pmI’ve only been at ACNM for 3 years, but I would guess that is one of the many struggles. There are so many ideas about how midwifery should be branded, yet it’s so difficult to boil it down into a simple message that accurately portrays midwives. There’s so MUCH information to communicate and so many misconceptions that need addressed. One simple, powerful message would be a godsend to those of us who have been chipping away at the problem for years.
catrin commented on Oct 18 10 at 9:45 pmGreat post. Super informative.
Sam Ford commented on Oct 18 10 at 11:15 pmAgreed completely that finding a simple and elegant way to distill the message of what a mid-wife is would really be key, Melissa. Ceridwen, I’m glad that my Fast Company piece has provoked this conversation, and it’s one that I hope continues on and pulls in a variety of people across the midwives community. I wonder, for instance, how many of those who have chosen to use a midwife might be willing to write and share their experience, in a way that shows the full breadth and depth of the types of people who ultimately choose midwives instead of doctors. Would be great to see the midwives community come together and put some resources behind this discussion, not to move away from the audiences that have most strongly advocated midwifery in the past few years but to demonstrate how fundamental midwifery has been to the history of our country and culture and that it should remain a readily available option for families of many types, backgrounds, and beliefs.
mbaker commented on Oct 19 10 at 12:53 pmI would be willing to write about using a midwife. I am on my 2nd go round with one and even though I needed to have a c-section last time I and my husband are still very pro-midwife and we are not the world’s crunchiest couple.
Alissa Wehrman commented on Nov 03 10 at 2:36 pmwasn’t there a plan to make a movie out of The Baby Catcher by Peggy Vincent? this was a few years ago…
melisa commented on Feb 17 11 at 11:04 ami’m a midwife in Indonesia (asia), n i continue my study of midwifery.in indonesia, there’s a profession who try to look for the fault of the midwife’s work. even in this near time there’s a discussion about “making a delivery mother comfortable in order to get a safe delivery by minimalizing the intervension” but the final is just like a “hot discussion” between midwife and doctor and also it has been discussed about a plan of a new rule that delivery must be helped by the doctor.wow..why there just always a pro contra between midwife and doctor?hmm..how to make it good then because we just have the same orientation which is helping a mom and baby and keeping them health.
Paula commented on Mar 10 11 at 12:01 pmI found your blog via FB…..social media is working!!
I’m currently a direct-entry midwifery student at Bastyr University in WA. Those that have commented also provide food for thought about this issue. I’m not sure if anyone is still reading this thread, but I’m compelled to speak out.
I think that Sam and all of us could have a much better chance of branding midwives if midwives would simply come together at the table to respect and promote each other. I believe that the lack of cultural understanding of midwives in this country is in direct relationship to the often contentious and territorial nature of the “types” of MW’s.
One of the main arguments that the ACNM makes about the LM’s or CPM’s is the “lack of consistent educational standards”. It might surprise you to know that I, a future LM/CPM, actually agree with that statement but I believe that instead of marginalizing the CPM or making her “other” or “hippie” or “uneducated”, I propose that we come together, in an accordance with promoting incremental change, to try and support legislation and changes that lead to an educational path that everyone…..midwives, medical community, health dept, or consumer…..feels comfortable with. And, from the other point of view where hospital midwives are sometimes called “medwives” by the homebirth community, I propose that we all come together to promote incremental change in hospital protocol to support those midwives in providing the care that they clearly desire to. We all became midwives to help women…..ALL of us!!
As midwives, standing and working together, we have a much better chance at promoting the midwifery model of care to this country. Divided we fall…..or fail….or, at the very least, have a much more difficult time of it. And the general public feels and senses this division and, thus, has a difficult time framing MW’s. This lack of public respect and understanding is a mirror…..we don’t really understand each other. Yet.
The good news is that Holly Kennedy, CNM, who is the new president of ACNM with more contemporary leanings, and Gerdine Simkin, CNM as president of MANA (which represents all types of midwives in North America…LM’s, CPM’s, CNM’s, CM’s, RM’s, TM’s) are in an excellent place to begin building bridges. Both organizations have found common ground, most notably in recognizing the lack of midwives in this country and the need for mutual support. Also, there is an historic conference taking place at Niagara Falls next November. It is the first joint conference between CAM (Canadian Association of Midwives) and MANA with collaboration with ACNM.
I certainly hope that something strong and powerful comes from that meeting and everything this conference inspires. The time is ripe for us to come together, stop the marginalizing (which happens on both sides) and start promoting midwifery care for home, birth center, and hospital in a way that we can all be proud of.
I firmly believe that as soon as midwives begin solidly embracing each other, we will see the public follow suit and maternity care will change in this country. Yes, it can be as simple as that.
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