Midwife Zeliha Erdogan: It is the midwife's duty to reveal the mother's power to give birth

Interview: Zuhal Eyüboğlu

Unfortunately, in the last 30-40 years, the physiology of births that have become medicalized all over the world has also turned upside down. Pushing midwives in the second plan is one of the most important factors that disrupt the functioning of a natural and instinctive act like birth. But fortunately, in recent years, the number of births in which midwives have an active role has been increasing.

We know very well that before a certain generation, anywhere in the world, they are usually born with a normal birth. Moreover, almost all babies were born at home. Here, midwives played the leading role in the safe delivery of those births. Midwifery is one of the oldest professions in history. Without them, the birth rhythm will be disrupted. In the last 30-40 years, are the births not changed because the power of midwives has been pushed to the second plan in births? Didn't cesarean increase because they were not supportive enough at birth? Until the birth school and approaches emerged, believing that women should give birth in accordance with their nature and that babies have the right to be born naturally… Thus, the number of midwives who proudly and duly perform the midwifery profession has increased in recent years. Birth Preparation Instructor Midwife Zeliha Erdoğan is one of these wonderful midwives. We talked to my dear friend Zeliha about midwifery profession from past to present. We hope that our pleasant conversation, which seems to be long but you will end in a snap, shed light on your births ...

• Dear Zeliha, as a devoted midwife, can you tell us about midwifery?

Midwifery is the world's first holistic healthcare group, which is the oldest traditional and historical healthcare service and the most important in terms of function. Care at the core of the midwifery profession has always been "woman-centered". Although midwifery is known as the person that helps birth, it has developed and changed by expanding the area of ​​care according to time and countries. It is a profession practiced by reliable and responsible professionals who provide care for women during pregnancy, childbirth and postpartum periods, provide necessary advice, deliver under their own responsibility, care for the newborn and work in collaboration with the woman. Accompanying the birth of a new baby, providing support to a mother with labor pain in coping with pain, perhaps being with her when she needs help the most, creating an environment that will enable the mother to welcome the birth and her baby with enthusiasm, Ensuring a healthy and respectful participation is a must for the midwifery profession.

• Both in Turkey and in the world was one of the most loved and most respected profession actually heard midwifery. What happened to the midwifery profession not considered as valuable as it used to be?

Midwives who once served a woman who gave birth were very respected. They were well held in society, they earned well and they lived a good life. Most normal births are accompanied by midwives at home, and this is considered a sign of social status. However, unfortunately, nowadays midwives still do not see the value they deserve due to the fact that births are transferred to hospitals over time, the birth authority is given to specialist doctors and midwives cannot provide one-to-one support during the birth, that is, they have to deal with more than one pregnant at the same time. Although they belong to one of their oldest professions ...

Nevertheless, interest in midwives and midwifery profession is increasing in this period when normal birth has come to the fore again and is supported. I hope that women will soon regain their place at birth and the value they deserve, with the support of their births and midwives.

• If midwives do not have much authority in most system births, then how do midwives perform their duties?

Currently, midwives in our country are passive in the health system, but they are defined as auxiliary health personnel and they are seen as the assistant and under the management of the doctor, caring and helping pregnant, puerperant and newborn. In very few state hospitals, deliveries are carried out by midwives, while in the rest and private hospitals, deliveries are performed under the supervision of a doctor. Likewise, in the family medicine system, low-risk pregnant women are monitored under the supervision of a doctor. When this is the case, pregnant women have switched to the status of patients and this has reflected in us as the increase in our cesarean rates.

• What is being done to restore the old value of the midwifery profession?

The World Health Organization (WHO) and UNICEF put emphasis on strengthening the midwifery profession in the successful implementation of Maternal and Child Health and Primary Health Services. First of all, midwives should not be employed in other fields other than their academic education, the number of midwives working in the field of birth should be increased.

The personal rights of midwives should be improved, their mandate and responsibility areas should be expanded, midwives should be able to take an independent role in the follow-up and delivery of low-risk pregnant women, and use their own autonomy. In this way, women will receive the support they deserve at birth, they will have more respectful birthing environments and accordingly our normal birth rates will increase and our cesarean rates will decrease.

• What should we know about midwives?

Midwifery is a health discipline that combines science and art, based on spirit and ethical values. Its most important feature is that its field of duty is based on supportive, caring and preventive health services. In sexual and reproductive health services; It ensures that couples are prepared for parenthood, and birth preparation programs are prepared and carried out with pregnancy preparation training in the pre-pregnancy period. In addition, she performs normal pregnancy follow-up, detects risky situations and takes the necessary precautions.

It helps birth of low risk pregnant women. I want to open the helping part as follows: The midwife does not give birth because the mother and the baby give birth. The midwife only helps with medical or non-drug techniques when help is needed. In addition to these, midwives manage the birth process, monitor the health of the mother and baby during birth, and take measures in emergency situations. Performs the first care and examination of the newborn in the postnatal period. It performs resutation when necessary. It monitors 0-6 years old children, provides training and consultancy services on pregnancy, birth, newborn care, family planning.

• It is said that the number of midwives is insufficient in our country. How is this situation in the world?

This is actually one of the mistakes! Turkey has a number much higher than the world standard as a midwife of 57 thousand. The fact that it is known and evaluated as insufficient is due to the fact that only 2000 out of 57 thousand midwives work in clinics related to birth. Many midwives are employed as family health workers in different clinics or family health centers as nurses. Of course, this inevitably reflects on births. When a midwife has to take care of mothers who have given more than one birth, optimum conditions cannot be achieved in the birthing environment. Women cannot receive uninterrupted one-on-one support at birth. The situation is not very different in the world. In almost all countries, the number of midwives is insufficient. But in our country, the number of midwives is sufficient, and the number of midwives working in the delivery area is insufficient! This is a little more noticeable as our fertility rate is higher than in other countries.

• One of the concepts that has been popular in recent years is the concept of "doula". While it is getting popular, people are confused about doulalik. Can you talk about this concept?

Doula is a person who has received non-medical training to provide physical, emotional and informative support to women and their families before, during and after birth. Doulas cannot control the heartbeat of the baby, do not examine and give medicine because they do not have medical training, midwives can do all of these. When the number of births that midwives have to take care of at the same time is high, Doula's are there to provide physical, emotional and non-medical informational support that midwives cannot give, if they cannot give sufficient time and uninterrupted support to a mother.

• The number of midwives who have received full training like you is increasing day by day. Well, isn't education in midwifery school enough, why did you get doula education? Can you explain that a little bit too?

In fact, this concept of doula midwife has emerged to be more distinctive. Otherwise, there is no such concept abroad. But all midwives there have both "medical" and "traditional" midwifery characteristics. This is not the case with us.

In our country, midwifery education is given at the level of basic midwifery education in the best way and towards the complications that may occur at birth. However, it falls short in terms of complementary medicine and non-drug relaxing techniques and traditional midwifery methods. It is being taught as undergraduate courses in some new universities. Master thesis studies are also being done, but these are not enough yet. That's why we need to improve and enrich our profession with the trainings and workshops we receive.

This is the easiest way to explain the difference between midwives and midwives who have only undergraduate education. Maybe we could have gone easy here. Maybe we had to persistently and persistently explain that we, as midwives, take a holistic approach to pregnant women. But we also learned a little on the way. Still, I don't think there is anything we lost professionally. It is known that there are midwives closer to traditional midwifery when we say “midwife” and pregnant women question this. Somehow they reach these midwives.

Midwives do not necessarily need full training. Now there are workshops held at universities and congresses. They can join them and improve themselves. The important thing should be to understand that birth is a philosophy by being aware of the fact that we serve only one purpose, and to ensure that the mother and baby deliver the birth in the most traumatic state by focusing on them, respecting their preferences.

But let's also get a training for a doula; Then we are both midwives and doula, we cannot deny this either. But of course, midwifery is a very special and beautiful profession acquired through an undergraduate education. Most importantly, it is a profession and one of the most important professions in history ... Whatever title we bring before it, next to it, behind it, it never overshadows midwifery, on the contrary, it enriches it and actually shows how we protect our profession.

• What are the characteristics of "Doula midwives"?
  

• They provide the necessary support and trainings in international standards (Lamaze, Hipnobirthing, Active Birth etc.) to prepare the pregnant for the birth for the prenatal period.

• By putting the mother and baby in the center, they provide full and uninterrupted support without judgment and criticism, regardless of the mode of delivery.

• In addition to medical treatments, complementary medicine, non-drug relaxing techniques and traditional methods are applied according to the needs of the pregnant and the course of birth.

• They create a beautiful environment where the body will perform its functions, take care of privacy and ensure the highest level of oxytocin hormone release.

• They help pregnant women cope with pain.

• They help the expectant mother find the most suitable position for herself by being active at birth.

• Sometimes they are just there to remind her that she can do it with a warm touch to her waist, sometimes just holding her hand, and perhaps most importantly, every woman passes through and feels like I can't.

• They accompany the mother and the baby's journey, witnessing the first meeting and the first LOVE.

• Tey provide care not only with the moment of birth, but also in the postnatal period according to the needs of the mother and baby.

• They take continuous training, follow national and international congresses and participate as much as possible.

• Can anyone reach the "doula midwives"? Are there any points to consider when choosing these midwives?

Yes, anyone who wishes can easily reach professional midwives who are professionally developed and enriched, closer to traditional midwifery. There are many midwives who have developed themselves in terms of professional and personal development, work in private hospitals, and work in state hospitals with the trainings they receive, the workshops they attend. Our number is increasing rapidly day by day. Not only mothers, but also my colleagues should pay attention to this issue. Mothers should definitely question where and how the people they work with received their education and how they approached themselves and birth. It is very important for my colleagues to question and evaluate the competencies of the experts they will receive training while participating in a training or workshop, and whether they provide training in accordance with international standards.

• As a midwife who follows congresses abroad, do you think the approach to the concept of birth has changed in the world?

Obviously, there is not much problem with the physiology of childbirth, especially in northern European countries where midwives are more competent and better equipped. In all countries of the world where midwives are removed from births and because of the medicalization of the birth, the birth process has changed and the perception of birth has started to change completely. In the last century, with the rapid increase in cesarean rates all over the world, the eyes turned to the physiology of birth and the factors that caused this change.

As a result of all the searches about birth in the world, it has been understood that the "holistic approach", in other words, the "holistic approach" is the most important factor in the physiological follow-up of birth. In other words, it is very important to follow the births as a whole with their medical, physiological and psychological aspects!

• How do you think an ideal and healthy birth should be?

Birth is a spontaneous natural event and it is a woman's duty. It has the power to give birth and has been passed down genetically from generation to generation. Mother and baby are programmed for birth and they instinctively know what to do at birth. In the birth preparation trainings, we encourage the mother to discover this information rather than load it with information, and support her to reveal the power within by increasing her belief that she can give birth.

In a natural birth that starts spontaneously, the body and the baby are in perfect work, where they know what to do. Ideally, the mother and her baby should be supported physically and emotionally by creating an environment that will support this perfect functioning of the body. In this way, the mother-to-be and the baby will not be exposed to any medication and intervention unless necessary, and the control of birth will pass to hormones secreted naturally. Giving birth is an act of love and each birth is unique to the mother and to her baby. However, we all share the same female physiology and the same special orchestration of our birth hormones. This excellent hormonal regulation is most favorably revealed when labor is not interfered with, increasing safety for both mother and baby. The duty of midwives at birth, too; To rely on the mother and her baby, to unwittingly offer them a confident and loving birthing environment that will unleash the power of giving birth and ensure the maximum release of birth hormones.

The enthusiasm capacity of mothers at birth is both personal and universal. This is the mother's birth right and the will of her body. In order for such a birth to take place, the mother must leave the birth with maximum satisfaction. An ideal, positively enthusiastic birth takes place in this environment of love and trust. In this way, the mother is not exposed to intervention and can take her baby to the breast as soon as she is born and establish a strong bond with her baby.

"Let your birth moment turn into an enthusiastic symphony"

Dear Zuhal, I want to ask you this time with your permission. You gave both births with midwife support. What do you think is the place of midwife in a mother's life?

Zuhal Eyüboğlu: You thought very well, dear Zeliha, of course I will gladly answer. As a 20-year-old mother-baby editor and a mother who delivered both births with the school of natural birth, I have determined that midwives are the conductors of the births… My experience showed me: One-to-one support; It is very, very important for the expectant mother to be guided towards the healthy one according to the course of the birth! I use the term "enthusiastic" a lot when describing my births. Many people ask me with surprise, "Would birth be enthusiastic?" that… Yes, it really happens. First of all, every expectant mother who learns and researches about birth, goes to a birth-focused birth preparation course and is supported sufficiently by the birth team; She is able to give a healthy, traumatic, seamless, positive and “enthusiastic” birth full of love with her baby. Your moment of birth can turn into an enthusiastic symphony. Of course, this applies to births where everything goes well in terms of health! Every expectant mother who wishes to give birth can also give birth that she will never forget by "learning the birth" and "demanding both the right to give birth and the birth of her baby".

The same midwife was accompanying both of my births, I would have felt alone, helpless and cowardly without her guidance during labor. Both of my births proceeded differently and my midwife had different directions consistent with these differences. She took my hand during my births, she massaged me when needed, said "You can do it", guided my breathing and encouraged me with her positive words. At the moment of meeting with my baby after both births, I never forget her silent, strong stance with a sweet smile on her face, and the slow blinking of our eyes as if we just glanced at her saying "It's done, this is it." That is why I think that midwives who manage births exactly and positively can never, ever be filled in the hearts of mothers. Good thing you are!

• Would you like to send a common message on behalf of all midwives?

We now know that birth is the job of mother and baby. But we also know that one of the moments in life that a woman needs the most support is the moment of her birth. My message on behalf of all midwives is: “Births should be such that a midwife takes care of each pregnant woman and provides uninterrupted one-on-one support. There is no birth without midwives!