MIDWIFERY IN SOUTH CAROLINA
Past. Present. Future.
HISTORY OF MIDWIFERY IN SC
Midwifery in South Carolina has a long history that it shares with the history of humankind. The word midwife means “with woman.” Midwives are honored as cornerstone members of societies worldwide for ushering in the new lives that sustain every culture.
In the 1930’s, South Carolina’s public health officials recognized the need for formal training of midwives and programs were established under the leadership of Dr. Hilla Sheriff, a native of Orangeburg and a Harvard-trained physician. At that time, there were several thousand midwives in South Carolina and their training yielded good results. They traveled over rough roads, sometimes on foot or by horse-and-buggy, to care for the families in their communities.
As the twentieth century progressed, pregnancy and birth became safer due to improved sanitation and hygiene, better nutrition, the invention of antibiotics and the new option of bearing fewer children by using birth control. An increasingly organized system of health care and advancements in our capacity to address childbearing challenges also provided distinct advantages.
By 1970, our health officials determined that times had changed. They implemented an experimental plan to turn childbirth into a medical event for everyone. This had already been done everywhere in the United States except the South. The master plan was to eliminate independent midwives and establish the mechanistic view of childbirth that prevails today.
Consequently, South Carolina midwives were called to meetings where they were informed that their services were no longer needed. It was a shock as there were citizens still desiring the personal care and conscientious service of midwives. Many appreciated the midwives’ reluctance to interfere unnecessarily in the birth process. Not all mothers wished to be institutionalized for childbirth, nor did all mothers wish to take drugs or to be separated from their newborn babies. Nevertheless, the government proceeded to be an ally in establishing such practices as normal.
MIDWIFERY IN SC TODAY
Having decommissioned the midwives of the previous era, the South Carolina Department of Health and Environmental Control (DHEC) moved in 1976 to retire the statute under which the program had operated. In public hearing of the matter, a new voice arose. It spoke to the rightful place of midwives in maternity care and demanded that the state make provision for them. South Carolina became one of the first states to update the midwifery profession and dozens have followed suit. Today’s licensing began in 1982.
DHEC oversees the routes of training, testing and regulation of South Carolina Licensed Midwives. Student midwives must complete a DHEC-approved course of study and a clinical apprenticeship that qualifies them to care for both mother and baby. They are under the direct supervision of a Licensed Midwife, Medical Doctor or Nurse-Midwife for two to three years. After achieving licensure, continuing education, peer review and case reporting to DHEC are required.
To effect healthy outcomes, midwives strive to care for the whole woman. Nutrition counseling, exercise guidelines, stress management, compassionate listening, health education, resource referral and preparation for birth typically complement the clinical assessments of each visit. Prenatal checkups are provided on a regular schedule in collaboration with medical personnel as required or needed. This approach yields exceptionally low rates of premature delivery, exceptionally high rates of successful breastfeeding, reduces the occurrence of low birth weight infants and supports the family unit.
Labor and delivery care is provided in the home or in birth centers. Women are free of restrictions in labor and give birth in the manner they choose. Close observation and patience with nature facilitate safe deliveries. Newborns are welcomed gently and remain with their mothers. Licensed Midwives tend to mother and baby’s stabilization, monitoring and examination with special attention to parent/infant bonding.
Midwife care reclaims traditional ways of being “with woman,” in combination with the best of modern bio-technical theory and practice. It encompasses physical and emotional needs while fostering self-determination throughout the childbearing cycle. Utilizing the Midwives Model of Care, most women are able to have successful pregnancies resulting in normal childbirth, healthy babies and happy families.
LOOKING AHEAD
There is hope for the future of our country’s mothers and babies if a sensible health policy is developed which implements the evidence-based changes we so desperately need. Forty years of research data demonstrates that practices consistent with the Midwives Model of Care achieve superior results in maternal and neonatal outcomes and decrease costs.
Yet, technology-focused care continues to rise in the US, increasing expenditure without producing better health, and costs for childbirth services have exploded. Cesarean section, with all its attendant risks and costs, has become the most frequently performed surgery in the nation; premature deliveries are on the upswing; Neonatal Intensive Care Units are overflowing; and too few babies are being successfully breastfed. Sadly, the United States of America is at the bottom of the world’s health care statistics heap except for one outstanding benchmark: we outspend everyone in the world when it comes to pregnancy and birth.
Consumer demand for the Midwives Model of Care has grown nationwide. Midwives are the specialists in care for low-risk pregnant women and their babies. Physicians are the specialists in care for pregnant women who are ill or experiencing complications. In the countries with lower costs and better results, midwives greatly outnumber obstetricians.
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Birth is the place to begin building a positive future for South Carolina. Safe, effective and satisfying maternity care starts with evidence-based health policy. We should begin that future now.