medical procedures, firstly because the obstetrician will always “play safe”; secondly, because now that they are there, rather than waiting or returning later, they may want to induce to get the job done; and thirdly, because that is what they are trained to do.
   In the event of their not needing to be urgently called, or their attendance at some truly pressing situation delaying their arrival, how many times have we heard the story of the top obstetrician, paid handsomely for his / her services, who doesn’t make it to the birth, let alone during the long and arduous hours of labour preceding? Sometime after the birth he wanders through the wards, checks your charts, asks the midwives how did it go, asks how you are, and then off they go on their rounds. Many women can feel cheated and realise too late that they didn't need such a person in the first place. Alternatively, if they are great worriers and completely untrusting of all but the “top experts”, they may have panicked during the birth because the person they placed all their trust in wasn’t present to look after them when they believed he / she would be.

	~Midwives~

   Whether in hospital or at home it is midwives who are the primary care givers when a woman is in labour. Even if you have engaged the services of an obstetrician, it will be the midwife monitoring your responses to labour, who will assist you if you want help during the early stage of labour, and who will be guiding you through the latter stages of labour and the birth. In most public hospitals, most uncomplicated births are handled fully by a midwife. Midwives are also trained in pre-natal care and peri-natal care of infants. There are actually 3 types of birthing care-givers to which the term midwife can refer. To avoid confusion, I will refer to them from here on as (i) nurse midwife, (ii) lay midwife and (iii) spiritual midwife as follows.
   The registered, nurse trained midwife is someone who (at present in Australia) must first train as a general nurse and then complete a further year of midwifery training. In many other countries, midwives are not general nurses but trained specifically in midwifery through what is called “direct entry” midwifery training. This system is soon to be implemented in Australia after much agitation from midwives who argue that midwifery is not like general nursing and should be considered a separate profession.
 

   Unlike a doctor or anaesthetist, a midwife is not authorised to administer epidural or pudendal blocks, or labour inducing drugs. Neither is she able to carry out procedures such as high forceps delivery or caesarean section like an obstetrician. A midwife is not a paediatrician and so is untrained to deal with serious complications in a baby after birth.
   Nurse midwives may be tenured or independ-ent. They may be young or old, female or male, they may be mothers themselves or not. A tenured midwife works as an employee of a hospital or Birth Centre. She is duty bound to act within hospital policy and, in a labour ward, she may be excluded from doing certain procedures such as suturing, even though she is capable of doing them. If complications arise during a birth, she will be required to call a doctor to the scene to make further decisions. They may be advocates of a natural birthing approach or they may not. Some will happily use interventionist medical options over a more natural approach to birth and infant care.
   Independent midwives (also registered and nurse trained) are a small and dedicated group who work outside the public health system. They are available to be employed on a one-to-one contract by the mother and attend births at home or, may have visiting rights to attend the births of their clients in labour wards or in Birth Centres. In the home setting they are not restricted by so many rules or a time frame as to how a birth should proceed, and are therefore more able to find creative solutions in consulta-tion with their clients.
   The lay midwife is someone who has not done the official medical or general nursing training, but has much knowledge about midwifery gained from attending and assisting many births, often under the tutelage of a more experienced midwife. They are usually of a mature age since they are nearly always mothers themselves, and they are always advocates of a natural birthing approach since it is lay midwives who have been the upholders of the natural birthing tradition all through the ages. Such midwives are attracted to their career because it is their calling. They have traditionally attended women in their homes, re-enforcing the idea that birth is a normal, non-medical part of life.
   In previous eras, and still in a few remaining cultures today, there was never this dependency upon a medical presence at births. It was the older and wiser women who supervised the birthing events of the women in the community.