Duchess Kate and Prince William, Duke of Cambridge made headlines when choosing to use midwives (Pictured right: Arona Ahmed and Jacqui Dunkley Bent)

by William F. McCool, PhD, CNM, RN, FACNM

Childbirth is the strong basis by which all species continue to exist, and for human beings it is most often a demanding, yet healthy journey. Over the millennia, mothers have given birth with the support of fellow women who learned the strength and willpower that laboring brings.  These supportive caregivers have had several titles throughout history, but the most common of these is “midwives.”

News headlines recently noted that the Duchess of Cambridge delivered the latest royal baby, Princess Charlotte, with assistance by Midwives Arona Ahmed and Jacqui Dunkley-Bent. That’s correct – assisted by midwives – not by advanced technological machines or instruments. There was no mention of obstetric physicians nor high-risk maternal-fetal medicine specialists. The Duchess knew something about childbirth, even of the royal, most-anticipated variety, that many women know – childbirth is a normal, physiologic process which has existed since the evolutionary dawn of the human race.

What the Duchess acknowledged by her method of delivery was that babies are not delivered by nurses, physicians, specialists, or even by midwives. Babies are delivered by their mothers. Modern midwifery has evolved from a time when the field was seen as an apprenticeship to the present day where most midwives in developed countries hold college degrees, often at the graduate level.

Midwives continue to attend the majority of births worldwide, as they have for centuries (even though in the U.S. midwives only attend about 12% of vaginal births). We recognize that birthing mothers are strong and committed to the well-being of their babies. We also know that the female body has been created to physiologically advance our species in a nourishing manner, and not proceed through labor in an unhealthy state that requires specialized intervention or hospitalization. Yes, there are times when the birthing process does not advance in a normal, expected manner, and yes, most women in the U.S. have come to presume that their labors and births will occur in hospitals. However, modern midwives are trained extensively to recognize those times when events are out-of-the-ordinary and require medical intervention, and most midwives, at least in the U.S., do now work in hospitals. What this means is that even during those rare occasions when the unexpected occurs, midwives are trained to work collaboratively with our physicians colleagues to optimize the healthy outcome of each woman’s birth, and no matter what the situation, midwives continue to focus on the well-being and needs of both the mother and her baby.

Duchess Kate acknowledged and appreciated this fact, as does the United Kingdom’s National Health Service, which trains and supports the midwives in the U.K. who attend close to 60% of all births in the land of Princess Charlotte. Ironically, many of the world’s leaders and researchers in the profession of Midwifery have been educated and practice here in the U.S. The historical reasons for this are complex, political, and cultural in nature, and are the subject for another blog. Suffice it to say that the choices in pregnancy care and childbirth brought international attention to what millions of other women worldwide already knew – pregnancy and childbirth are innately healthy processes, and what birthing women need the most is to be surrounded and supported by professionals whose practice is based on this fact. What pregnant and birthing women throughout the world need, whether living in a rural village in an underserved nation or in an opulent royal palace, are the care and support of midwives. The growth and health of the human race has long depended on midwifery and will continue to do so in the future.

Dr. William (Bill) McCool has been practicing midwifery since 1984 and has been a Midwifery faculty member for over 25 years, first at the Yale School of Nursing and currently at the Penn School of Nursing.  Since 1999 he has been the Director of the Midwifery Graduate Program at Penn, currently is in clinical practice at the Hospital of the University of Pennsylvania (HUP), and teaches and conducts research at Penn.