ļ»æEpisode 210 - Itā€™s bad but thereā€™s hope
[0:00] Welcome to the Great Birth Rebellion podcast. I'm your host, Dr. Melanie Jackson. I'm a clinical and research midwife with my PhD, and each episode, I cast a critical eye over current maternity care practice by grappling with research and historical knowledge to help you get the best out of your pregnancy, birth, and postpartum journey.
Welcome to today's episode of the Great Birth Rebellion podcast. I'm your host, Dr. Melanie Jackson, and today's episode is all about what I learned and my reflections from attending the International Confederation of Midwives Conference. I've recently, like a few weeks ago, gotten back from Portugal, where I attended this conference. It's a congress, and over 3,000 midwives from all around the world, over 100 countries, came together, to talk about midwifery, the state of maternity care in the world, and all of the new and upcoming research and information that's, you know, helping us with our work.
[1:08] Then I hopped over to London as the keynote speaker for the Association of Radical Midwives Conference. It's their 50-year anniversary. And in the middle of all of that work and speaking and attending, I opened my emails to discover, that I'd been reported to the Health Practitioner Regulation Agency here in Australia, which are the people who register midwives in Australia and regulate our work. They've sort of set out the standards for midwifery in Australia. Unfortunately, the standards are based on the International Confederation of Midwife Standards, so I know that I'm compliant, but it was quite poignant to receive the notification while I was away trying to learn how to be the best midwife possible. Anyway, I'm going to talk about all of that in this episode, which I've called, it's bad, but there's hope. So hear me out. And before I get into it, I want to give a big shout out to Poppy Child, who is the sponsor of today's podcast episode. She recently had her third baby, which was a bit of a curveball. And we're going to share with you about that in a later episode, but she had a third baby recently. And she's the creator of the birth box, which is a hypnobirthing resource that is filled with tools to help you navigate pregnancy, labor, birth, and postpartum.
[2:36] Especially the sensation and overwhelm of labor and thousands of women have already used the birth box to navigate their labor and birth and Poppy shared this story with me from a woman who was determined to have a different birth next time that she did her first time the woman said after a difficult first birth I wanted things to be different the birth box helped me let go of fear trust my body and have an empowered birth experience that I didn't think was possible Now, Poppy is giving Great Birth Rebellion listeners 25% off the birth box and the oxytocin bubble soundtracks that go with it. So just click the link below in the show notes and use the code word MELANIE at the checkout to claim your discount. All right, so let's go. In this episode, I'm sharing everything that I learned at the ICM conference. It's super juicy because I'm fired up by what happened at the conference and what happened while I was away being reported. And the work that I was doing for the Association of Radical Midwives at their conference. Now, before I go any further, I just want to kind of explain a little bit about being reported to APRA and what that's all about. So, as I said, as I was at the conference, I received a complaint. The person was anonymous, which is usually what happens and totally fine because, of course, they want to protect their identity. No one wants to admit that they've reported you. That can be a bit frightening.
[4:00] And they complained to my registration body because of something that I said on the podcast, but that became a little snippet on my social media page. Now, the particular sentence that I said that's under investigation, which was the topic of the complaint, I said, if everything is normal and well, you do not need an obstetrician. So that was the crux of the argument.
[4:22] The feeling from the complainant was, is that this was an unethical statement to make. So my registration body has asked me to provide a response to the complaint. And that's where the problem lies. It's not with the complaint. The problem lies with the registration body who is supposed to know what a midwife is asking me to defend this complaint.
[4:48] Now, I am absolutely willing to do this to defend the definition of the role of a midwife and I will defend it to the very, very end. Like this would be my life's work. If I had to describe it, it would be to try and explain midwifery to the world and why everybody needs one. So of course this week I doubled down to declare outwardly and openly that making a statement if everything is well and normal you do not need an obstetrician I've done nothing wrong, and I simply stated an absolute truth which explains the exact role of a midwife, and also of an obstetrician. So that's my stance on that and I want to be clear I'm in no way opposed to people reporting me it's anyone's and everyone's right to submit their concerns, to opera of course i actually expect to be reported because i'm out there and speaking and i have a following of course people some people are not going to like what i have to say some people are going to place blame on things that i say, and then choose to make me responsible for certain things.
[5:56] But the main, so what I'm trying to say is I'm not opposed to being reported. I expect and understand that. What I am feeling concerned about is that APRA chose to pursue the complaint, considering that I haven't violated any codes of conduct or standards of practice, and that all I said was what the definition of a midwife was, which APRA themselves and the Nursing Midwifery Board themselves have adopted the International Confederation of Midwives definition of a midwife. And the words that I used are very similar to the words that are used in the ICM definition. And I'll explain what that is later. So more on that as we go. But sit back sisters, this is an unapologetic recollection and reflection of what went down at the ICM conference and the incredible circumstance of being reported.
[6:52] For simply stating my scope and role as a midwife. So it's bad but there's hope. Now let's get into it.
[7:02] So this year's ICM conference was focusing on the topic of one million more midwives and this came after a year-long campaign from the ICM to bolster the midwifery workforce. And one million more midwives was born from some recent research which calculated that if the midwifery shortage was addressed and the estimated numbers of shortages of midwives to become enough to, actually cover the needs of women through their reproductive years... There was a paper that calculated approximately 980,000 midwives would be required to fill the gap in maternity care. So 1 million more midwives is a nice round number. But so the research suggested that if the world was supplied with, or, you know, 980,000 new midwives were created or utilized, the ones that were already existed were fully utilized, that greater access to midwifery care would result in a 65% reduction in maternal and newborn deaths by 2030.
[8:15] So what they've identified is that the work of midwives is incredibly impactful on the outcomes of labor and birth for women and their babies. And I was expecting to be inspired and regenerated, to keep working for you all and championing midwifery. When I went to the conference, I was ready to be inspired. And if you've been listening to the podcast for a while, you know that I do
[8:41] not have a habit of dancing around topics. So I was really grateful. In the first session that I attended at the conference, it was on the topic of over-medicalization. And I love that they used that word because they didn't shy away from the reality of the over-medicalization of childbirth. And this whole session was about the impact of the overuse of life-saving interventions, such as cesarean and induction. And the session started with the chief midwife of the world. I call her the chief midwife of the world. She's the ICM chief midwife, Jacqueline Dunkley-Bent.
[9:21] And she started the session by declaring, this session will be unapologetic about the consequences of the over-medicalization of childbirth.
[9:29] And I can't tell you the size of the sigh that I let out of like, oh, thank goodness. Now, to give you some context, the room was so full that there was about 200 midwives outside of the door who couldn't get into this particular session. Unfortunately, they picked the wrong room size. and there was a lot of people interested in this topic. So I was sitting in this tiny little space on the floor. I couldn't really see anything, but I was so honed in with my listening and the room was so quiet because we were all so invested in this topic of the over-medicalization of childbirth. And I was so happy because one of my fears was that this conference was going to be soft and fluffy and a bit of a fantasy session with meaningless hopes and prayers that were going to be offered about this issue. But by this introduction that the chief midwife gave, I knew that this was going to be a collection of truth tellers who were going to be clear about the over-medicalization of childbirth and the harm that it's doing to women. And this is what the session was focused on. The harm that is caused to women by the over-medicalization of childbirth. And we have to acknowledge that there is a point at which if you start overusing medicine, it actually starts to create negative impact, not a positive one. And that was the focus of this particular session.
[10:54] And when I went to ICM, I had a really good picture of what was happening in Australia.
[11:01] A picture of what was happening in the UK, in the US, but I didn't really fully understand if our experiences as midwives with the over-medicalization of childbirth and the challenges that we have as midwives just to work in our profession. I wasn't sure if that would translate to the rest of the world. But as it turns out, the Great Birth Rebellion podcast has spread so far and wide, so much so that actually when I arrived at the conference and really for the entire five days, I was flooded with people thanking me for the podcast, who knew about my work, who were like fans. And it was beautiful and I loved it. And I felt so regenerated by hearing that my work had spread so far. But what I was really curious to understand from all the midwives who had come up to me was what is their experience of midwifery in their country. And I heard from midwives from Norway, Estonia, Czech Republic, France, all over, they were all over the world.
[12:04] Hundreds of different countries were represented. And I heard how far the podcast had reached. And universally, when I spoke to midwives about their experience and the work they're doing, everywhere in the world, midwifery is being challenged. Everywhere in the world, midwifery is being repressed. Everywhere in the world, midwives are fighting just to do their work as midwives. And everywhere in the world is suffering from either too little or too much medicine.
[12:38] So I realized what I understand to be the challenges of midwifery and midwifery care and maternity care for women are actually universally experienced all over the world. My experience was similar to every other midwife that I spoke to. So throughout this session, it also became obvious and there was no mistake that the over-medicalization of childbirth is occurring all over the world. We are all currently experiencing it and it's becoming obvious that every country, there is the conundrum of too much, too soon or too little, too late. And I heard from one obstetrician in India who was saying actually in one single day in their maternity care service, during shift times, there was too much intervention. too much unnecessary intervention. And then just by the way that the hospital is structured, all of a sudden, if you come in in the afternoon, there is too little and not enough medical care. So even in a 24-hour period in a single service at the same location, they're experiencing the two extremes together. So this is the issue with maternity care. We haven't found the right balance. I did think though that there would be some countries where the remnants of physiological birth was still thriving, that maybe there were some golden.
[14:01] Spots in the world, Goldilocks spots in the world where physiological birth was allowed to exist in freedom, but actually everyone was lamenting the reduction of physiological birth and the sudden increases in cesarean section. Some countries reported rates as high as 80% cesarean section rates, and some countries had 100% episiotomy rates. And the thing that really struck me about the increasing cesarean section rates, and I've said before that when you start to increase the use of cesarean section rates, you will automatically increase the risk of maternal and newborn deaths, as a result of the ongoing and cascading risk of cesarean section. It's not just about that first day or the risk the surgery on the first day or in the first week, it's about that woman's risk throughout her entire life.
[14:55] And I was really struck by and reminded that we exist in this huge, diverse world where we can get into this echo chamber where we think that our reality is the only reality. So when I say things like, when you increase cesarean section rates, you also increase maternal and newborn deaths. People think that's really inflammatory. They're like, how dare you? It's a life-saving tool. And that's totally true. But it's a life-saving tool and possibly lower risk where you are but we had presenters who were from countries that are lower resource that don't have access to ongoing maternity care and one of the presenters said.
[15:36] When you give a woman a cesarean section in my country and you increase her risk of placenta accreta and we know that we know that every time you have a cesarean section, your risk of placenta accreta and abnormal placentation into the uterus and into that uterine scar, that increases every single time you have a cesarean section. And he said, placenta accreta for a woman in my country, it means death for that woman and baby. So while the placenta accreta might be manageable in higher resource countries, in a lot of other countries in the world, cesarean section just like in well-resourced countries increases the risk of placenta accreta, and placenta accreta equals death in many countries for both the woman and the baby.
[16:26] And these were the issues that were being brought up in this session. Now I was introduced to a person named Frank Louwen at the ICM and I'm so grateful that I went if only just to learn about this man, Frank Louwen. He's the president of FIGO, which is the International Federation of Gynecologists and Obstetricians. He's from Germany. Partway through the session, it was during the question panel, he just yelled out during question time in response to a question that there is never an indication for episiotomy. And I thought, whoa, that's a bit outlandish because I did think, okay, there's a few good reasons for an episiotomy. He was so solid. There is never a good reason or indication for episiotomy. And he's a clinical and political obstetrician, but his prevailing message when he did his presentation for this session was that every intervention should have an evidence-based indication. And if there's no medical need for an intervention, it shouldn't be done.
[17:35] So this was his statement and I loved it, but I had an issue with it and I'll explain why. He said every intervention should have a clear indication and that indication should be evidence based and if it's not the intervention shouldn't be done and he was speaking to the over medicalization of childbirth he was saying you have to justify every single intervention that you are going to give to a woman is it actually necessary and does that necessity actually is it rooted in evidence. Because other speakers in the session really highlighted the fact that the physiology of labor and birth actually has a purpose. It's actually important for the adequate transition of the baby and the woman into a healthful life. And if you don't need to skip over the physiology of birth, if there's no good reason to skip it over, don't. It's too valuable or thing to just flippantly throw it away on unnecessary interventions. So when he was talking about this, that every intervention should have an indication.
[18:40] Firstly, I knew I was in the right place to gather information and dialogue to add to my own intentions to protect and restore the very premise of physiological birth and the ideology of physiological birth and the defense of normal physiology for women during labor and birth. But I knew I was in a room of other champions all over the world who were doing the same. So although they were explaining, yeah, it's bad out there. It's not good where we're at. I could see that there were some really clever and invested people who were interested in improving healthcare for women and babies, and that they all believed that midwives were the answer. So I took a big, deep breath. Great.
[19:24] So while I sat in the session and listened to presenters talk about the 100% episiotomy rates in some sessions and the climbing cesarean section rates. And Professor Soo Downe explained how in the UK, their rising cesarean section rate is also correlating with a rise in poor outcomes for women and babies. And I thought, whoa, this is bad. But then I also remembered, we're not really in a much better position in Australia. In fact, our newborn perinatal mortality rates have gone up. They're the highest they've ever been in 20 years, despite an increasing cesarean and induction rate. So what we're seeing statistically both here in the UK is that as the induction and cesarean section rates go up, so do the complications for women and babies. And as we're seeing on the charts, increase in perinatal mortality for babies. And eventually it will be mums as they continue their.
[20:23] Child birthing career. But what I do need to tell you before you sink into your very deep pit of despair about the state of birth in the world, is that there is a solid global pushback against the over-medicalization of birth that is bigger than the setting that you're currently sitting in. There is this huge movement and push for physiological birth and midwives and FEGO, the International Federation of Gynecologists and Obstetricians have partnered with the ICM with this same intention. They can see that the answer to maternal health and child needs all over the world is not an increase in medicine. It's an increase in midwifery. And that's what they're all petitioning for. And that's what this session was all about. Reducing the overmedicalization, increasing the midwifization, that's not a word, increase the midwifization of birth so that every woman, if she wants, could have a midwife at her birth. And that's where we see better outcomes for women and their babies.
[21:36] Now, in this session, Professor Soo Downe from the UK explains some research statistics that showed that in the US, physiological birth rates are down to 5%. And here in Australia, I've roughly estimated that our physiological birth rate is around 3%. That represents the percentage of women who don't give birth in hospitals here in Australia. If you give birth in a hospital, you're highly likely to be exposed to some interventions that would mean that your birth is not entirely physiological. Even, you know, the injection for the birth of the placenta, once you have that, you've interrupted physiology. So around 3%, and that's generous, of births here in Australia would fit the bill for a fully physiological birth.
[22:23] And this means that physiological birth is near extinction and the presenters encouraged us who were listening not to be despondent. And I'm going to say the same thing to you. I do believe there's this huge, massive political push for midwifery and physiological birth. So I was very heartened, but they encouraged us to think of solutions and act on them on an individual level. And I love that. I love solutions that I can enact myself without having to rely on anybody around me. So they asked to think about a solution and immediately it came to my mind and it was probably based on something I'd heard on the first day of talks because,
[23:02] you know, this is how your brain works. It just finds the information that was in there. So immediately I scribbled this down in my notebook. I wrote, how to solve over-medicalization.
[23:12] How to solve over-medicalization. Here we go. Don't focus on the problem of over-medicalization. Focus on the solution. And the solution is for midwives and obstetricians to be able to visibly and clinically understand the theory and practice of physiological birth and how to support and enhance physiology for every single woman. And then once practitioners understand physiology and how to support it, we, the ones who understand, should teach it to upcoming clinicians who will replace us and then keep passing down the knowledge to prevent the extinction of physiological birth.
[23:50] So that's all. Basically, each midwife has to take responsibility to learn about physiology and how to support it. However, we aren't really being taught that it's not really supported in our current maternity care systems. So each midwife has to take responsibility for that to make sure that we preserve physiological birth and the understanding of it. So my solution was that each individual should pursue an education in physiological birth. Now, here's what I want to tell you about how I'm going to be part of that solution. Because as it occurred to me, I thought, oh man, guess what? Guess what is the very unique skill that you have, Mel? I kind of identified two pretty good ones, maybe three. My entire career has been attending women who are giving birth at home and caring for them all through their pregnancy birth and postpartum so the things i've gathered is a deep and intimate understanding of what physiology is i can recognize it in a heartbeat, and then what i can also recognize is when physiology is no longer working and it's the time to seek further care from a specialists, from an obstetrician, from a pediatrician, from somebody else, when things.
[25:14] Stop being physiological and become pathological, that's the time when my mid-referee scope ends and we include another specialist into the woman's care.
[25:27] Now I realized, I was like, whoa, that is your skill set, Mel. And also what I realized is not very many midwives can say they have that. A lot of midwives, as desperately as they would like to understand physiological birth, just simply don't have the opportunity to watch physiological birth enough to have a deep understanding for it. Because many midwives are working in settings that don't allow the unfolding of physiological birth. And we can see that in the stats. around three to five percent of births are physiological which probably means that around three to five percent of midwives are given the full opportunity to even understand physiological birth. So what's the remedy? The remedy is that, I need to spend the rest of my career passing on every little single bit of knowledge that I have so that hopefully you can go into your career understanding physiological birth and how to support it.
[26:28] Here's where I want to give a very quick mention of something that I'm about to offer for only 200 midwives. I can't do it for everybody, obviously. I'm one person. But I want to offer 200 midwives a career-long opportunity to learn from me about physiological birth. I for your entire career want to be a resource for you to just pick my brain and learn everything you possibly can about physiological birth and how to support it now in the link there is a waitlist button because I can only do this with 200 midwives at this time.
[27:08] There's a link down there to get on a waitlist and I'm going to open up this opportunity in October 2026 and that's something you're interested in. If you desperately want to understand physiological birth and you want me to walk you through that for the rest of your career, that's what I'd love to offer you. The opportunity to learn about physiological birth from me who's been doing it for 18 years. Just click the waitlist button, get your name on it because that's how I'm going to share about this information. All right, more. More from ICM. So back to this session about the over-medicalization of childbirth, sometimes I wonder if maybe I've trapped myself in this echo chamber and maybe I'm overstating the impact of the medicalization of childbirth. So every now and then I do, I take a big peek out of the box that I've built myself into to see if the reality is different to maybe how I've constructed it in my head. And I very quickly realized that I am still on track with understanding that over-medicalisation is actually happening and it is actually impacting women and babies negatively. It's accelerating in its activity and in how much it's negatively impacting women. And we are past the point where medicine...
[28:27] Has been a help to women and babies, and now the overuse of medicine is becoming a problem. So just like the overuse of medical procedures is a problem, the underuse is also a problem. So it's the classic too little, too late, or too much, too soon. That's where we're trapped in the global context of midwifery.
[28:46] So Professor Soo Downe was continuing to talk in her session and use some terminology that was descriptive and helpful as we explain the realities of how over-medicalization has happened and how it's allowed to continue to happen. So birth has been medicalized. There's no doubt about that.
[29:09] But what Sue was mentioning is that it's continually medicalized and it's becoming over-medicalized. So now I've got this terminology. So she spoke about this terminology of diagnosis creep and disease mongering, where women are being led to believe that around every corner a new ailment is waiting to pounce on them. And so this is the classic, like ticking time bomb story that women are told over and over and over again, that when you're pregnant and labor and birth, there is a constant risk that something's going to go wrong. And so you need to put yourself in a safe space, I'm using adverted commas, with medical practitioners who can act at any moment. So this is the medicalized way of describing birth.
[30:00] So what happens through the process of medicalization, and this is a well-documented process, it's not me sort of making up things, but the process of medicalization relies on, medical people redefining normal things, normal physiological things as pathological. And once you define something as pathological, that starts to come under the umbrella of sort of the purview of medical management. I mean, that's the job of medicine and medical practitioners is something's wrong. They've got a thing that could fix it. But first, the thing has to be classified as wrong. So that's the process of medicalization, describing something that is probably completely normal as pathological. And by that mechanism, bring ordinary and everyday events like pregnancy and birth under a medical jurisdiction. And if you redefine something as pathological, you then gain permission and responsibility to fix it. So the problem is, though, that most pregnant and birthing women are not experiencing a medical event. They're just pregnant and giving birth, and it only becomes a medical event when something is wrong. And here is where I had my issue with Frank Louwen's statement of you should only give an intervention where there is a clear evidence-based indication.
[31:26] And while I agree with him that every intervention needs an indication.
[31:32] With this diagnosis creep that Sue spoke about, what's happening is that the medical maternity care system is inventing indications for interventions. They're inventing reasons to intervene by reclassifying physiological things as pathological and saying, see, now we have to fix it. The problem is, is a lot of these invented indications are not evidence-based. However, clinicians don't realise they're not evidence-based and they will go ahead and do what they've seen and what they've observed and what they've been groomed to do. And they will present them as evidence-based indications when they actually are not. And this has been the whole intention of the Great Birth Repellion podcast is to help women and midwives work out, I mean, and clinicians and doctors, any healthcare provider, just work out, what the evidence says so that you can have information and research to help make decisions about which interventions are actually evidence-based. And then women can work out which interventions are evidence-based and which interventions are actually invented for a pathology that maybe was also invented.
[32:53] And this is where women start to talk about necessary versus unnecessary interventions. A necessary intervention is one that's given where there is a clear evidence-based indication and medical need for it. And an unnecessary intervention is one that is given where there's no clear indication and medical need. Some of these interventions are just given routinely and these are the ones that women talk about as being unnecessary, clinically unnecessary, no indication for. So then what does evidence-based care look like? So in this same session of the over-medicalisation session, can you tell it was my favourite one of all at ICM?
[33:33] So Anna Afg-Uglas was her name. She's the chief executive midwife of the ICM. She reminded us that evidence-based care is centered around the provision of midwifery care. And we heard at the conference in the opening ceremony from the Bangladesh health minister who reported that in Bangladesh, they've managed to half their maternal mortality rate by prioritizing the provision of midwifery care to women. And Anna echoed this, reminding us that every woman needs a midwife and some need a doctor. And Anna positioned this idea of every woman needs a midwife and some need a doctor as an evidence-based standard of care. And the reason everyone in this session, doctors, midwives, researchers, and politicians, we're talking about midwives as the answer to being the appropriate and adequate maternity care providers.
[34:29] Is because midwives are the global profession whose job it is to be primary health care providers to women throughout their reproductive years. This is our job. That's what we're trained and qualified for. And the ICM global definition of a midwife, which APRA here in Australia has accepted as the definition of a midwife. So APRA, the Nursing Midwifery Board, the World Health Organization, the Australian College of Midwives, all acknowledge the ICM definition of a midwife to be the authoritative one. And here's what it is. And this is part of my argument against my complaint to APRA, is that what I said, was exactly in line with the ICM definition of a midwife, and all of these bodies, APRA, NMBA, World Health Organization, ACM, use the ICM definition of a midwife as the authoritative message. So, In case you were wondering, a midwife is a person who has successfully completed a midwifery education program that is based on the ICM essential competencies for basic midwifery practice.
[35:39] That's something that I've done. That's something that Australia is part of. The midwife is recognized as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labour and the postpartum period, to conduct births on the midwife's own responsibility and to provide care for the newborn and the infant. This care includes preventative measures, the promotion of normal birth, the detection of complications in the mother and child, the accessing of medical care or other appropriate assistance and the carrying out of emergency measures. The midwife has an important task in health counselling and education, not only for the woman but also within the family and the community.
[36:27] This work should involve antenatal education and preparation for parenthood and extend to women's health, sexual or reproductive health and childcare.
[36:37] A midwife may practice in any setting, including the home, community, hospitals, clinics and health units. So this definition of a midwife demonstrates that a midwife is a responsible and accountable health professional charged with the responsibility to conduct births and provide care for the mother and newborn. This care includes the promotion of normal birth, the detection of complications, the provision of emergency measures, and the accessing of appropriate assistance when needed. Now, this is the midwifery definition that's been accepted by APRA and the Nursing Midwifery Board, and the ICM definition of a midwife supports the statement that I originally made in my complaint. I'm coming back to it. Can you tell them a little bit sore about it? If everything is well and normal you do not need an obstetrician that's true because the icm definition of a midwife that's been accepted all over the world says exactly that, because uncomplicated pregnancy and birth care is within the professional scope and competency of midwifery practice and midwives may practice in any setting with, or without obstetricians present because that's our skill set and that's our job. We only include obstetricians as medically indicated because they can provide life-saving interventions when the need for interventions exceed our scope.
[38:02] And that's what I'm including in my response to APRA as I respond to this complaint. So at the ICM, we were encouraged to do midwifery and unapologetically defend and advance the work of midwives. I'll say that again. At the ICM, we were encouraged to do midwifery, and unapologetically defend and advance the work of midwives, because the ICM and the current research shows that when you utilize midwives for the care of women and babies, the outcomes are better, than when you don't access the care of midwives.
[38:44] So here's what I've gathered from the ICM. Number one, do midwifery. But what is midwifery? So midwifery, I've already given you like a textbook answer. But it means understanding physiology, recognizing it and know how to work with it and wait for it to unfold without hurrying it unnecessarily. And Frank Louwen said, if there's no reason to intervene, don't. That's coming from an obstetrician. If it's fine, don't do anything. Wise and watchful waiting. And of the speakers that I saw there.
[39:25] There was this expression of profound loss in the confidence that midwives have, in just being with physiological birth, which is contributing to the loss of physiological birth and the de-skilling of the midwifery profession, so much so that midwives are losing the ability to even recognize physiological birth because they so rarely see it. And this is something I want to remedy in my new lifelong career, you know, mentorship to you. So again, I'll remind you the link down below for the waiting list for that. I'm absolutely hell bent on helping midwives to firstly even recognize what physiological birth looks like and how to sit with it gently and wise waiting to wait and see.
[40:16] And then it's about keeping the balance of the too little, too late and too much, too soon and knowing when it's time to intervene and when it's time to leave things well alone and give women a chance to let her body physiologically function as it should. This means you have to know what physiology looks like. You have to know what's normal and what's not, but you can only know that by sitting and watching physiological birth and gleaning things from the outcomes to try and understand.
[40:47] What's normal and what's not. Because the medical definitions of what is normal for pregnancy, birth, pregnancy and postpartum are not accurate. We've already learned a lot of these pathologies have been invented. The boundaries are too small on physiological birth. We need to start fully understanding what physiology is actually capable of. So the main thing challenging midwifery and physiology today, is the extinction of physiological birth and then midwives having very few chances to even learn midwifery fully because we're often being expected to operate as obstetric nurses and medical handmaidens. So the solution is to stop focusing on the fact that birth has been over medicalized. We know the next thing you have to focus on is what are you going to do to rekindle midwifery skills? We've de-skilled as a midwifery profession in our work as midwives. And I can hear midwives all the time saying, oh, the obstetricians have de-skilled. They don't know how to do anything these days other than cesarean sections. That's an overreaction of what I'm having. This is just some of the things that are being said. But we keep pointing to the obstetricians saying they've de-skilled. They're not doing breach births and twin births and this and that and that.
[42:01] We've forgotten to look at ourselves as a midwif profession. We've de-skilled as well. We've forgotten physiological birth. So let's take some responsibility over reclaiming that and reclaiming our understanding of physiological birth so that we can be the solution to the over-medicalization of childbirth.
[42:20] Now, number three, Frank Louwen, my new favorite person, the president of FIGO said, intervention should only be used if there's an evidence-based indication. And midwives are great at this, at only intervening as indicated, as needed. Now, he said that physiological birth prepares the baby for extra uterine life, and I would say the mother for parenting and loving and caring for her baby. He said that labor and birth have a purpose. Don't skip it without a clear medical indication. That's what he said.
[42:52] And he also said that the detection of risk, I love this sentence, Frank Louwen. He said that the detection of risk is not an indicator or reason for intervention. I'm going to say it one more time, Frank. The detection of risk is not an indicator or reason for intervention. Just because there is a risk or a chance that something might go wrong it doesn't mean an intervention is the only or best option and I interviewed Dr. Andrew Bissett not long ago on the podcast and he said in his episode, he said obstetricians need some obstetric courage to wait and watch and only intervene if the risk turns into an actual problem and not a theoretical one. And we have to remember, actually midwives are doing the same thing, just so trigger happy on just interfering before the complication actually occurs. And from my very new favorite line in a recent research paper, so I did a talk at the Association of Radical Midwives and used this research paper, I'll make sure it gets into the resource folder for the podcast. There's a line in there, which I'm sure that the researchers didn't think anyone was going to pick up on and love, but this is my new favorite sentence. Controlling risk is not the same thing as enhancing safety.
[44:17] Mic drop. Controlling risk is not the same thing as enhancing safety. And finally, to drive at home, and I realize there might not be a chance to learn about physiological birth in many places, but if high resource countries are seeing a maximum of 5% of births being physiological, how can midwives learn to be midwives? That's my question. Firstly, it's going to have to be our responsibility to learn midwifery again, to rekindle midwifery.
[44:49] But I want to tell you a story. I went, while I was at ICM, I went to a whole session that was about physiological birth. And I thought, fantastic, there's midwives from all over the world. Maybe there's something that somebody else knows and has seen and practices that are happening all over the world that I have no idea about, that could be really handy as we support physiological birth. I wanted to get better at attending physiological birth. So I went to this session thinking, great, ready with my notebook, ready to take notes, tricks and tips, tell me what you're doing over there, what can I do for the clients that I'm caring for?
[45:32] And I went and the session started with a simulation of a birth. They had these like birth simulation pants, simulation of a birth. And as I was watching it, I thought, oh, they're giving us like a what not to do example. But then when they finished, quite excitedly, started asking the room about what they thought about the birth. And midwives in the room were kind of really positive about the scenario that they just witnessed but what I saw.
[46:12] Was a large number of clinicians around the woman who were all very noisy who were talking to the woman non-stop while she was pushing out her baby, they were using language that was very baby centric things like whoa you're crowning and I thought the woman doesn't need to know, that what's happening to her body not what's happened anyway what's happened to the baby, I'm rambling now but anyway in my head this was a what not to do scenario but it quickly occurred to me that the midwives in the room were looking up to it as like a what to do scenario. And I thought, oh man, have things gotten so bad that what we just saw is a representation of physiological birth and the behavior of midwives in it. So then we had an opportunity to break off into groups and sort of practice physiological birth scenarios with these simulator pants. And it started with one of the teachers of the session referring to the clinician as nurses. And I thought, whoa, we are midwives.
[47:25] A man referring to the women as patients. So already really medicalised language. And the midwives were invited to sort of simulate these physiological birth scenarios. And there was lots of hands-on, clamping of the cord, use of oxytocin medications routinely, lots of talking and engaging with the woman at this time where we were supposed to be facilitating oxytocin release. And as the session went on, I felt myself becoming more and more distressed, thinking, oh no, have we so far lost physiological birth that at a physiological birth session, I'm witnessing routine medicalized practices being passed off as physiological birth standards. And I started actually visibly shaking and I thought maybe I would cry I was so enraged and fortunately I was there with my work wife Ashley Ansley and, I said Ash we're going next for this, these scenarios we're going to show them what we do at home birth and what physiological birth care actually look like looks like I'm not saying I've got it right but a hundred percent knew that birth could be managed in a far less interventive way very safely.
[48:53] Without all of that interruption and as I kind of stepped forward with Ashley to say that we're going to go next and I did a little spiel about how upset I was about what I'd been seeing in the session, I just couldn't hold it in I know it was really out of place, but our group kind of went silent but then got really excited and whipped out their phones in order to film Ashley and I enacting this physiological birth scenario. And I was surprised. I was like, look, there's actually nothing to see here because I'm going to say so few words. And what you're going to see is just what unfolds for a physiological birth. And as it was, Ashley was on all fours. Her baby was being born into her own arms. I had to say very little because, you know, in this scenario, this simulated scenario, everything was going perfectly fine. There was nothing for me to do because this is a physiological birth. The woman's body was functioning as it should. There's not a whole lot for me to do unless the woman needs some kind of verbal reassurance or information, or she has some questions or anxieties.
[50:03] And so the baby came out and immediately went on Ashley's chest. And I just quietly watched and waited. We kind of fast forwarded the clock and we're like, okay 45 minutes later and Ashley went oh I think I feel like there's something in my bottom and I explained to her that it's probably your placenta and it's going to need a little bit of gravity if you want to push it out yourself so she popped up onto her knees and the placenta came out, and then sometime later after she'd sat more with her baby quietly and warmly all wrapped up and we gave her some food and we checked her blood loss and everything was normal, and about three hours after her birth, we thought to cut the cord.
[50:45] So this scenario played out and while everyone was filming, I just thought there's nothing to see here because this is just a normal physiological process, but everyone was so grateful to just see how little is necessary in physiological birth because when birth goes well, almost nobody is needed.
[51:05] So it was after this workshop where I'd hoped and desperately wanted to learn some more skills in physiological birth, I realized that I really know a lot. And of all the midwives in the world, barring a small percentage, I know an incredible amount about physiological birth. And what's more is that I have a platform to share it. And that's the plan. I've committed the rest of my career and mate I intend to be around for at least another 30 years and I want to tell you all and equip you all to understand and help facilitate and support and defend physiological birth so that's what I'm offering.
[51:55] Giving you all of the things that I know about physiological birth and my ability to keep researching and keep learning and keep communicating that. I want to give you that knowledge and that skill that's in me. And I want to share it with you for your entire career. So here is what I'm offering. At the moment, I can only offer it to 200 midwives, but I want to give you career long mentorship. I told you already, I'm planning on being around for another 30 years. I don't know how long your career is going to be but for however long it is, I want to be there to help you understand, learn about physiological birth, research and evidence and be there for you the whole time. I can offer it to 200 midwives. If you're interested in this opportunity to just pick it right brain non-stop for the rest of your career, click the link in the show notes to join the wait list for the Assembly of Rebellious Midwives. I'm going to open up this opportunity in October, 2026. And if you want it, that's when you've got to be on the wait list so I can email you when it opens. All right. That's all I want to say about that.
[53:08] And I realized that this podcast was a whole lot of bramble that I learned about at the ICM, my experience with my current reporting, the state of midwifery and the over-medicalization of childbirth. But I'm here to help rekindle and regather physiological birth from extinction. That's the skill of a midwife. And I want to give it to you. That's what I was inspired to do through this time at the ICM and the Association of Radical Midwives Conference. So if you're interested, just join the waitlist down below. I'm your host, Dr. Melanie Jackson. This has been the Great Birth Rebellion podcast. And sisters, it's bad, but there is hope. I believe that we can do this. I will see you in the next episode of the Great Birth Rebellion podcast. To get access to the resources for each podcast episode, join the mailing list at melanethemidwife.com. And to support the work of this podcast, wear the rebellion in the form of clothing and other merch at thegreatbirthrebellion.com. Follow me, Mel, @MelanietheMidwife on socials and the show @TheGreatBirthRebellion. All the details are in the show notes.
This transcript was produced by ai technology and may contain errors.
Ā©2026 Melanie The Midwife
