Image may not be everything….but it’s a lot. What is image but perception and impression of an individual or group without personal intimate knowledge of them?

There is, in my opinion, a very definite misperception and misimpression of midwifery as a profession, and I think that is one of the key points at the heart of the OB-vs-Midwives debate. The thing is that I don’t really blame OB’s for our image problems…in many ways we’ve done it to ourselves!! (and I can’t for the life of me figure out why we did this)

When I say the word “Doctor” or “Obstetrician”…what’s the first image that comes to your mind? Probably something like this….


I know, that’s a man…so lets compare apples to apples. Here is another doctor…


Now, when I say the word, “Midwife”…what is the first image that comes to your mind? If you don’t have personal, intimate knowledge of the midwives in your area (a face to put the name to), it’s probably something like this….


That might be a slight exaggeration, but if it is it’s only slight. I don’t blame them – after all, their first experience with the word “midwife” was probably associated with this woman…


Oh sure, she looks all normal now…but here she is back when she was bringing the profession of Midwife back from the dead….


I bow to Ina May Gaskin and think she’s a beautiful woman inside and out – however, Ina May’s proverbial knees had been chopped out from beneath her by an image of “hippies” that preceded her, and unfortunately that image has not improved in recent years.

Look at the above images – doctors are competent, smart, serious about their profession. Midwives are fluffy idealistic women whose heads are in the clouds. We have made the image of ‘midwife’ one of lifestyle and not profession. To counter the cold misogynistic world of OB’s we show images of midwives hugging bellies, painting them with Henna, laughing with our clients while offering them a cup of tea. I believe that we have diluted the importance and respect our profession should be receiving by linking the word “midwife” with things totally unrelated to care of the family. Knitting, gardening, saving the world from injustice….all good things, but totally unrelated to the profession of midwifery. Rarely does the word Midwife conjure up medical training, knowledge, skill, expertise, intelligence….

PLEASE HEAR THIS ONE AND ALL: Intelligence and competency do not compete with gentleness and respect. They are not exclusive of one another!! Being an OB doesn’t mean you’re uncaring or disrespectful….and being a midwife most certainly does not mean you are less intelligent or less competent medically! I have been asked by potential clients if I wear gloves (????), what do I do if something goes wrong, how do we monitor the baby while in labor…

Can you imagine asking a physician these types of questions? I always wonder what they think they are hiring me to do as their midwife? If I don’t have emergency procedures in place, if I can’t respond to situations as they come up, if I’m not monitoring the safety and well being of that mom and baby every step of the way, why in the heck are they hiring me? Doctors are asked if they will be respectful, midwives are asked if they will be competent.

Which leaves a big problem in the public debate about home-vs-hospital, OB-vs-midwife….they can pull the dead baby card. After all, they may have the image of being Mercedes driving sons-of-bitches who just want to get back to the golf course – but at least they will give you a healthy mom and baby. Midwives may love you, but your baby is not safe in their hands.

And the OB’s make that claim almost entirely because of our image – not because of the reality.

I had a local OB take me out to lunch a couple of years ago – she asked how I’d feel about her sitting in on my practice for a few months. As she explained it to me, she felt that she was a GREAT surgeon, she had learned about everything that can go wrong during pregnancy and birth, felt very competent in dealing with these challenges and issues, and felt that her education was complete in the area of all of the pathologies that can occur. However, she explained…..she never learned about healthy and normal. She didn’t learn how to facilitate and deal with healthy and normal pregnancies, she only learned how to deal with the illnesses.

I had to really think about that request – an OB, in my office, watching how I work on a daily basis. HOW INTIMIDATING!! But the more I thought about it the more I realized that if I practice in a certain manner I should be prepared to stand behind that practice with pride! And so I invited her to join us – and for 3 months she did. She sat in my office observing my prenatals. She went to births with me. She asked me a zillion questions. She phoned her mother (also an OB) out of state after births to explain to her mother that she’d seen a woman birth ON A BIRTH STOOL!! She’d seen a waterbirth!

I’d attended hospital births for years before becoming a midwife – I know how skilled and competent physicians can be and am grateful for their expertise when things go wrong. However, this was the first OB I had met willing and open enough to want to see what we do and learn our side of it. We learned from each other, and she walked away talking about the lack of knowledge her profession had with regards to mine, and how lacking most OB’s were in the area of ‘normal and healthy’. I reminded her that in a different world they shouldn’t have be the experts on normal and healthy, that’s MY field…they should only need to know about the pathologies of pregnancy and birth and that it’s unfortunate that our country had made them feel like they had to be experts in both. In a perfect world, I would be seeing all of the normal and healthy…and sending them to her if they get sick or have complications.

Stephanie Soderblom LM CPM

I have been asked what I do for a living, and gotten surprised looks when I say I’m a midwife. “But you don’t look like a midwife!” What does a midwife look like? Not me, apparently. I wear makeup…I color my hair…I shave my legs – and none of these things have anything to do with me as a midwife.

There are plenty of furry-legged Birkenstock wearing hippie midwives braiding each other’s hair that are also intelligent and very skilled at medically caring for a mom and baby. There are also plenty of white-coats walking around hospitals who are in need of some serious therapy and are way too full of themselves to understand how dangerous they really are.

But it comes down to IMAGE. Most people, it seems, don’t want to look at the real statistics…outcomes, how many moms are dying and how many babies are dying and WHY! I scratch my head every day wondering why it is I can respect a doctor for their training in complications and surgery, never for a moment even WANTING to pretend to be a surgeon, but they look down on me with such distain and distrust even though I am good at my job. I am an expert at healthy pregnancy, and I am better at dealing with healthy than most of them are. I have fewer complications and cesareans than they do, in part, because of the way that healthy is cared for by me as opposed to how it is cared for by them.

I don’t want to be an OB anymore than I want to be an airline pilot. They are respectable jobs to be sure…but so is midwifery. I respect your ability to do your job – I wish you could respect my ability to do mine.


  1. Rachel Davis wrote:

    Very well said! Now, I’m dying to know who that OB was that sat in on your practice! 🙂

    Thursday, May 26, 2011 at 4:14 pm | Permalink
  2. elfanie wrote:

    The OB that sat in on my practice has since moved out of state. She did talk a lot about approaching medical schools to incorporate into their curriculum education on emotional effects on labor, doula support, the value of maintaining normal…

    Thursday, May 26, 2011 at 4:17 pm | Permalink
  3. Lisa Letkemann wrote:

    Well-written. I’m a family doc and practice in Canada, and have seen some of the same dichotomy here, though feel as though family docs are able to bridge the divide a bit – we know both the normal and abnormal (and hopefully have a better grasp of risks being real vs perceived) but also hopefully know our patients and can be more supportive, etc. Unfortunately, especially in larger cities, the specialist-dominated mindset of training means that fewer and fewer newer family docs are choosing to do OB.

    Thursday, May 26, 2011 at 4:57 pm | Permalink
  4. Rachel wrote:

    I loved this post. I so often feel this way about what I do as a doula also. I love research and want to learn how to best help a woman cope in labor. This includes so much more than just smiles and hugs and deep breathing. It’s about knowing and understanding how labor and birth work. I work to incorporate the mental, physical, and social.

    Having worked as a nurse in all aspects of women’s health. I understand the need to have specialties like the midwife and the doula. And I appreciate the education and hard work that goes behind all areas of care given to a woman.

    Friday, May 27, 2011 at 11:48 am | Permalink
  5. Anisa wrote:

    LOVE this post! We should collect photos of real midwives to show people! I can’t tell you (and probably don’t need to) how many people have been surprised at my midwife when they meet her. She looks so…normal!

    Friday, May 27, 2011 at 11:55 am | Permalink
  6. Carrie wrote:

    Really fantastic post!! I think you raise such a good point in that the “image”of a midwife does not align with the professional training and skill. Thanks for bringing it up;I will be spreading this far and wide.

    Friday, May 27, 2011 at 12:39 pm | Permalink
  7. Dou-la-la wrote:

    Thanks for this. I couldn’t agree more.

    Friday, May 27, 2011 at 1:12 pm | Permalink
  8. Justine wrote:

    Excellent post! I am a midwifery student and really hope to bring a fresh image of midwifery to my future practice. I love doing crunchy, healthy stuff but also love looking like a competent professional. I don’t think those two worlds are difficult to live in simultaneously…I hope that the families I work with feel the same 🙂

    Friday, May 27, 2011 at 1:39 pm | Permalink
  9. Christa wrote:

    I just had my first home-birth with a midwife, and I asked her if she wore gloves! Not because I thought she was incompetent, but because on the movie The Business of Being Born, it shows a midwife assisting in the delivery of a child without wearing gloves! It’s a valid question from someone who has had very little exposure to midwives like myself and truly was basing some of my knowledge on what I had seen in a movie!

    Friday, May 27, 2011 at 11:49 pm | Permalink
  10. elfanie wrote:

    Really? I hadn’t noticed that in Business of Being Born. There’s a midwife in the movie that doesn’t use gloves? wow…I’m..surprised. Not really in a good way. Thank you for sharing that.

    Saturday, May 28, 2011 at 12:29 am | Permalink
  11. Megan wrote:

    Thank you! So many excellent points made here. Also, to the OB who sat in on your practice: good on ya!

    Saturday, May 28, 2011 at 9:41 am | Permalink
  12. Crystal Sada wrote:

    Great job Stephanie. About the comment – the midwife who did not have gloves on in the Business of Being Born – I will have to go back and look. Don’t remember seeing that. But I once saw a doc catch a baby without gloves when a fast birth took him completely by surprise. I guess it happens but I don’t believe that means all midwives do this nor does it mean all doctors do. Not a question I would ask either unless I saw them coming at me without them.

    Monday, May 30, 2011 at 8:28 am | Permalink
  13. Soshanna wrote:

    What a wonderful post. I would love to see some real pictures of midwives that challenge peoples misconceptions as well as such crunchy natural doc pics 😉 Let’s see if we can get something going…

    Thursday, June 2, 2011 at 10:11 am | Permalink

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  1. Do I Look Like A Midwife? | Portland Midwifery on Tuesday, May 31, 2011 at 6:52 am

    […] a little torn in discussing the image of midwifery, to be honest. On one hand, I understand the need for social adaptation and conformation, and image […]

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