Midwifery Care and Normal Birth

Written by the Canadian Association of Midwives (CAM), this position statement on
midwives and normal birth reflects the position of the Association of Ontario Midwives.

Read the full statement below, or download the document. Also available in French.

Canadian Association of Midwives
January, 2010

Recent policy statements by maternity care provider organizations in Canada, as well as
the United Kingdom, have promoted normal childbirth and recommended a number of
system changes and best practices to support the normal labour and birth process.1,2
Underlying these statements are concerns about unprecedented rates of technological
and surgical intervention in childbirth, the use of caesarean section without medical
indication, and the health and social consequences that may accrue if current trends
continue.

The Canadian Association of Midwives (CAM) welcomes these important collaborative
initiatives toward reducing unnecessary intervention and restoring confidence in the
physiologic process of childbirth. CAM also welcomes ongoing discussion about the
parameters of normal labour and birth, the attitudes and beliefs that influence maternity
care practices, and the actions needed to promote, protect and support normal childbirth
as a healthy and meaningful event in women’s lives.3

CAM believes that midwives are making a vital contribution to interdisciplinary efforts to
promote normal birth and decrease the anxiety that often surrounds maternity care today.
Trust in the normal childbirth process is fundamental to the philosophy and practice of
midwifery, the language midwives speak and the care they provide to women. Midwifery
education includes the development of specific skills and clinical practices that facilitate
normal, undisturbed labour progress and spontaneous delivery through the efforts of the
mother, without routine use of drugs and interventions. For midwives, the concept of
normality rests on the physiology of labour and the capacity of women to give birth with
their own power.

A 2008 Cochrane review of midwifery-led models of care in developed countries
concludes that women attended by midwives are consistently more likely to labour without
major intervention and analgesia or anaesthesia, and more likely to experience a
spontaneous vaginal birth.4 Recent research in Canada also indicates that when midwives
are well integrated into the health care system, midwife-attended births, both at home and
in hospital, involve significantly lower rates of intervention and, at the same time, very low
rates of maternal and neonatal/perinatal morbidity and mortality.5,6 Midwives moreover
seem to achieve similar normal birth outcomes with women across the socio-economic
spectrum, in rural and remote settings as well as large urban centres.

Integral to the Canadian midwifery model are the standards and best practices that
support physiologic birth and optimize women’s childbirth experiences. Some of the
essential components of this model of care include:

• Providing continuity of care to build trust and partnership with the woman
• Sharing information and offering choices, including the choice of birthplace
• Actively supporting client decision-making and autonomy
• Allowing adequate time for discussion of individual needs and concerns
• Preparing women for the realities of labour while anticipating a normal birth
• Creating a calm and intimate birth environment
• Providing a familiar presence and continuous support during active labour
• Using non-pharmacologic methods to help women work with normal labour pain
• Encouraging free movement and instinctual behaviour in labour
• Encouraging fluid intake and nourishment as needed
• Encouraging spontaneous second stage “pushing” in the woman’s preferred position
• Supporting early labour at home as appropriate
• Supporting birth at home or in a birthing centre as appropriate

Qualitative research suggests that there are subtleties in the midwifery care process that “tap
into the woman’s personal strengths” and that women experience as empowering.7
According to Rooks, one of the underlying goals of midwifery is inspiring women’s confidence
in their own abilities in pregnancy, birth and motherhood.8 Taken together, the characteristics
of midwifery care seem to create optimal conditions for the intricately-balanced process of
birth to unfold – conditions in which women feel reassured, safe and supported to labour as
they wish. As a result the need for intervention and pharmacological pain relief is often
reduced.

While models of care that support normal birth are not exclusive to any profession, midwives
have a body of expertise that is essential to creating a normal birth culture. Changing
attitudes and developing practices to support physiologic childbirth require leadership and
mentoring from all maternity care providers who understand and can articulate the value,
meaning and transformative power of giving birth normally. Midwives in Canada look forward
to continuing collaboration and interdisciplinary initiatives to make normal childbirth a
common reality.

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1 Society of Obstetricians and Gynecologists of Canada. Joint Policy Statement on Normal Childbirth. JOGC
30(12); December 2008. Available at: http://www.sogc.org/guidelines/documents/gui221PS0812.pdf

2 Royal College of Midwives, Royal College of Obstetricians and Gynecologists, National Childbirth Trust. Making
Normal Birth a Reality: Consensus Statement from the Maternity Care Working Party. 2007. Available at:
http://www.rcog.org.uk/womens-health/clinical-guidance/making-normal-birth-reality

3 Young D. What is normal childbirth and do we need more statements about it? BIRTH 36(1); March 2009

4 Hatem M, Sandall J, Devane D, Soltani H, Gates S. Midwife-led versus other models of care for childbearing
women (Review). Cochrane Database of Systematic Reviews, Issue 4, 2008

5 Janssen P, Saxell L, Page L, Klein M, Liston R, Lee, SK. Outcomes of planned home birth with registered
midwife versus planned hospital birth with midwife or physician. CMAJ 181; September 15, 2009

6 Hutton E, Reitsma A. Outcomes associated with planned home and planned hospital births in low-risk women
attended by midwives in Ontario, Canada, 2003-2006: A retrospective cohort study. BIRTH 36(3); September
2009

7 Kennedy HP, Shannon M. Keeping birth normal: Research findings on midwifery care during childbirth. JOGNN
33(5); 2004

8 Rooks J. Midwifery and childbirth in America: The past, present, and potential role of midwives. Philadelphia:
Temple University Press; 1997