Hesperian Health Guides
Midwives and community health: Introduction
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For thousands of years, since long before there were doctors or hospitals, midwives have been helping women stay healthy, helping babies into the world, and helping families grow. Ask a woman why she prefers the care of a midwife and she will tell you that midwives are knowledgeable, patient, and respectful of her traditions.
Why are midwives such important and valued health workers?
- Midwives trust in the safety of pregnancy and birth, and have confidence that women can work together to protect their own health.
- Midwives often live in the communities they serve, so the families they help know and trust them.
- Many midwives spend more time with the women they care for than a doctor or clinic worker would. This helps midwives to better understand women’s needs, and to see danger signs.
- Most midwives are women. Many women feel more comfortable talking to a woman health worker.
- Midwives charge lower fees than most doctors or hospitals — valuing service to the community over the pursuit of money or power.
- In poor communities where there are few health services, midwives are often the only health workers.
For all these reasons, in most of the world midwives are the first and sometimes the only health workers women go to for help in birth or for any health problem. But midwives face a number of challenges in this important work.
Perhaps the biggest struggle for midwives (and for all health workers) is fighting sickness and death in women and their babies. Every year, hundreds of thousands of women die in pregnancy and during labor. Millions more are injured or disabled. Most of these deaths and injuries happen to women who are poor — who do not have enough food, or safe homes, or adequate medical care.
Most of the midwives of the world live in poor communities, and many are themselves not paid a livable wage. The people of each community must show midwives how important their work is by supporting them in the ways that they can. Local governments would also be wise to invest in midwives. These governments rarely provide midwives with adequate education or supplies, yet they rely on midwives to care for the many women who have no access to other medical care.
Along with being underpaid, midwives may struggle to receive the respect they deserve for their work. Doctors and others too often dismiss the contributions of midwives. When midwives are not treated as valued health workers — part of a community of health care providers who all share the same goals — their ability to care for women is hindered. Midwives may actually be locked out of the health system when a woman who has a health emergency is not allowed to bring her midwife with her to the hospital.
Traditional midwives (sometimes called TBAs) face particular problems. Many professional health workers, including professional midwives, see traditional midwives as incompetent or old-fashioned. These traditional midwives may be very knowledgeable about birth and skilled with plant medicines, gentle massage techniques, or other safe, effective practices. As more people leave their villages for cities, these midwives may be some of the only people preserving the knowledge and customs of their communities. Traditional midwives often work for little or no pay, but instead because of a belief in the importance of their work. Like other midwives, they do their work because they love women and babies, because they want to contribute to their communities, or because they are spiritually called to.
How A Book for Midwives can help
Midwives need accurate information to help them protect the health and well-being of women, babies, and families. They need strategies to fight poverty and the unequal treatment of women, and for working together and with other health workers towards health for all. We revised A Book for Midwives with these needs in mind. In this edition of A Book for Midwives, you will find:
- information needed to care for women and their babies during pregnancy, labor, birth, and in the weeks following birth, because this is the primary work of most midwives.
- skills for protecting a woman’s reproductive health throughout her life, because a woman’s health needs are important whether or not she is having a baby, and because a woman’s health when she is not pregnant affects how healthy and safe her pregnancies and births will be.
- safe, effective methods from both traditional midwifery and modern, Western-based medicine, because good health care in labor and birth uses the best from both Western medicine and the traditions of midwifery.
- discussion of the ways that poverty and the denial of women’s needs affect women’s health, and how midwives can work to improve these conditions, because changing these conditions can make a lasting improvement in health.
- suggestions for how midwives can and must work with each other, with other health workers, and with the larger community, because working together strengthens everyone’s knowledge and makes action to improve women’s health more effective.
The basics of midwifery care will never change. Women and families will always need compassionate and respectful care before, during, and after birth. And because midwives always benefit from learning more, we hope that the expanded and updated information in this book will help midwives everywhere learn new and lifesaving skills, and apply those skills for the good of the women, babies, and families they serve.