I was reading the Summer 2003 issue of ICAN's Clarion today and in reading the cover article, I pondered the word Institution. The definition is, in part, [n] an establishment consisting of a building or complex of buildings where an organization for the promotion of some cause is situated and [n] a custom that for a long time has been an important feature of some group or society; "the institution of marriage"; "the institution of slavery"; "he had become an institution in the theater". Thus we would look at the word institution as being either a building or an important custom of sort for a specific group. In looking at the latter, the "institution" of midwifery would then be what females have found to be important during the birth process and obstetrics would be what males feel are important regarding the birth process. In looking at midwifery and obstetrics, I personally could not think of a polarized opposite if I tried!

Midwivery honours women, sees birth as a normal process women experience during their life and, traditionally, rarely interfere with the process. Rather they support the mother emotionally and physically as she goes through this life-changing experience. It is a rare indeed for anything to go wrong when the mother is healthy and not fearful of the process. Why should a woman not choose to birth at home, just as she eats at home, exercises at home (or at least not in an institution where she is monitored in case of a heart attack), and showers and voids in the privacy of her bathroom. If all of these are normal body processes, why should she go to a strange institution, be cared for primarily by strangers in uniform and beeping machines which reduce her mobility and assume specific positions to birth in with out consideration for her comfort or instinctive knowledge to assume a different position?

Obstetrics on the other hand views birth as a train-wreck waiting to happen. Fear is central to obstetrics and prophilactic interventions are extremely routine... it is very rare that at least one intervention is not used at some point during a woman's labour. Even the movement from home to hospital is an obstetric occurance because of the fears surrounding birth. Certainly there are situations where obstetrics is life-saving, but in a proven 95% of births, mothers can birth normally without a single intervention. But the current 100% intervention rate and 20-26% cesarean rate clearly demonstrates the obstetrical model of fear. So why would a woman knowingly put herself at greater risk by placing her life into the hands of this model of care? The only reason I can conclude with is lack of knowledge and assuming that because obstetrics is practiced in an institution, it by that very fact must somehow be safer. Will our society, so focused on institutions, ever see the truth of what we have done to women by institutionalizing birth? Will we blame ourselves for the skyrocketing maternal and fetal mortality and morbidity rates, knowing that they were caused by our blind trust in institutions?

I am one of the survivors, though I am thoroughly scarred by my institution experiences. Four babies I have carried in my womb, all but one cut from me in an ambiguous guise of vague reasons... failure to progress, cephalo pelvic disproportion... and all because of fear. Some on the part of the physician, some on my part, none of them necessary. Without fear and with trust I would have not become one of the institution's morbidity statistics. It was only when I learned of midwifery, and was able to once again trust my body to birth my babies normally (no easy feat, I can emphatically tell you) was I able to birth my daughter as my body was designed.