Hello all,

I just put the phone down after talking to my IBCLC-study mate, who's a midwife, and a very professional one, I may add. ;-)
Thank you for all the explanations about the terminology concerning midwives. I combine several mails in this reply.
Thanks, Nina, for pointing out the need to be specific about the words you use. Of course, when a language is not your mother tongue, there may always be associations you miss out on. My English is quite good, though, and I decided to have a look in a dictionary for this specific word:
lay (NOT TRAINED) adjective [before noun]: not trained in or not having a detailed knowledge of a particular subject (Cambridge Advanced Learner's Dictionary).
This definitely doesn't apply to the Dutch midwives. Midwifery is, as in many areas, a very old profession in our country; their education takes up four years and includes apprenticeship with a midwife in a practice. Slowly but surely they get more independency during their education and perform more actions (sit in with consultations, pay home visits, measure blood pressure, touch the growing womb/baby to get a 'feel' with it, learn hand positions), but they're always supervised by an experienced, licensed midwife. There is *no* supervision from a doctor. They work independently and refer to a hospital when necessary, either beforehand (breech positions, mother pathology, whatever, and then the gyn takes over) or during labour, when an intervention is needed or the mother's or child's condition makes it necessary.
They are not necessarily (and mostly not) registered nurses, which is interesting, as nurses deal with sick people and midwives deal with, in itself, very, very healthy women (as they got/are pregnant ;-)).

Here, we have a division in first line, second line and third line health care.
First line: family doctor, nurse at home, dentist, physiotherapist, ánd midwife.
Second line: those doctors/specialists you can only go to with a referral from an HCP in the first line.
Third line: services that HCP's can use for their care, like specialized laboratories or an expertise center from an academic hospital (a hospital connected with a university, where education of doctors and research takes place under responsiblity and coordination of the university and/or the medical faculty).

This system is developed to keep health care costs lower: the family doctor may often be all a patient needs, so no need to see a specialist.
It also makes clear that 'normal', not too complicated situations are dealt with in the first line, which is therefore cálled the first line: it is the first HCP you go to, to maintain health or to deal with problems in an early stage, before it gets worse. The midwife is the samen story: she (usually a she, but there are a few he's in this profession ;-)) is all a healthy pregnant woman needs, so no need to see a gyn.
I like that. It emphasizes the normalcy of pregnancy. I felt very safe with my midwives, who were most certainly professionals and not lay ladies who like to see babies being born. :o) In fact, family doctors are allowed to do deliveries, but it seems to be safer to have your delivery guided by a midwife, as she sees many more pregnant women and delivers many more babies than a family doctor does.
I think I once heard (Heleen...?) this system developed like this, because a midwife used to be cheaper than a family doctor (who's a generalist, but with a university degree, unlike most midwives, who's education is not an academic study). Despite those origins, they are well respected professionals with a competent understanding of a natural birth.

I had all my four daughters at home and those were not fully similar to the video-clip we saw through the link here. (The checkered guy was so unexperienced and someone like that attending a birth, may greatly increase anxiety in a mother. He made remarks like "she's in extreme, excruciation pain right now!", and to the unexperienced eye, it may definitely seem so, but yelling may also be part of the process and not a sign of unbearable torment.) In most cases, a home delivery will be attended by the midwife, a childbed nurse or maternity help (dictionary says 'assistant/auxiliary midwife', but I don't think that is the right word, as a maternity help is not as highly educated as a nurse) and, of course, the father. Often, the biggest part of the delivery will even be done in matrimonial solitude, as the dilatation phase doesn't necessarily need a relative stranger like the midwife around. Feeling comfortable at home is good for oxytocin secretion and therefore good for contractions. Parents get instructions as to when to call the midwife, mainly focussed on signs like the waters breaking or contractions being less than x minutes away from eachother (I think it is 3 or 5, but it's been eleven years, so I can't remember and forgot to ask my sweet collegue.)
Contractions may stop, if a woman has to be transported to a hospital for some reason, because first she needs to feel safe again, before oxytocin will return and stimulate contractions again.
For an HCP, being patient in this phase and encouraging a labouring woman to focus on her breathing, reminding her that with every breath she takes, she helps her baby, is telling her that she and her child have to cooperate to get through this transition phase, which a delivery is: from life inside the womb to life outside the womb, but still clung to mom (at breast).

This is how I experienced my deliveries. Looking at the six minute clip brought back the memory of the intense joy of seeing our child for the very first time and having done the job on my own resources. Like someone else said: that was incredible empowerment for the years ahead. I wish not so many women were robbed of that experience by early interventions.
I'm grateful I had the opportunity of this choice, although in fact it was as little a choice as breastfeeding: we just followed our biological destination and were very fortunate (although not only fortunate, 'cause also very, very determined) to make it through like this. I was seriously, life threateningly ill and dehydrated after our third, and felt very sad she had to get formula for one and a half(!) day and the feeling of having her back at breast was undescribable. If only we could explain how wonderful it is to overcome difficulties with your child and how valuable those stories are when they get bigger... Well, I try to, time and again, and it has worked very often over the years. What a great profession we have! When that baby turns 25 or 30 and asks: "Was I breastfed?" and the mother can say: "Yes, I found someone who gave me the right information and I managed to nurse you quite a while"... then our work still pays off, even after all those years!

Warmly,

Marianne Vanderveen, Netherlands

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