The Biblical Model of Midwifery

My daughter, Charis, received a phone call this morning. The newly titled grandparents, aunts, and uncles wanted her to visit. We were missing sweet, little Julia Grace, the latest addition to our extended family. Julia's birth was indeed a family affair. Charis labored surrounded by her husband, sisters, and mother. Charis even received a brief visit from her dad, who came to exhort her to "finish the game" with the same tenacity she used to win at high school basketball! The loving hands and hearts of her family cocooned her with encouragement, praise, and practical support. My hands even helped the Certified Nurse Midwife ease little Julia into this world. I remember glancing up to see Charis looking from her newborn to the wet, tear stained faces of her husband and family.

The joyous birth of my granddaughter, Julia, was the highlight of my years of experience with childbirth. God had prepared me during the last 20 years to direct my daughter's labor support and assist in the delivery. During that time I gave birth to six children, served in the pro-life movement, helped women with crisis pregnancies, aided friends in childbirth, and participated in a medical study to assess the effectiveness of a trained woman's constant presence at birth. I am now a Certified Doula and Labor Assistant, enrolled in a Christian direct entry school of midwifery and have helped scores of women in childbirth. I will be seeking credentialling as a Certified Professional Midwife. But most significantly, I am studying Scripture to understand the "office of the Hebrew midwife." Care in this tradition of the Hebrew midwife encompasses and yet transcends care in the modern midwifery model. My daughter Charis, received care during Julia's birth by both types of midwives.

"Midwife is the oldest helping vocation after motherhood itself."¹ Midwives, not doctors attend more than 70% of the world's births outside the U.S. Inside the US the percentage is much lower due to the strong influence of the medical approach to birth. Midwives attend the vast majority of births in those industrialized countries with the best perinatal outcomes, yet in the United States, midwives are the principal attendants at only a small percentage [5%] of births.² The midwifery model is known as "with women" care. Unlike the medical approach, which tends to treat pregnancy like a disease, midwifery views pregnancy as a natural process. The midwife sees herself as a partner in health and as an advocate for the expectant mother and her family. True midwifery care is an "art of service."³ The midwife offers personalized, continuous one-on-one and non-interventive, maternity care (meaning limiting the use of technological interventions such as sonograms) to the healthy woman and infant. She continually assesses for normalcy and refers any deviations from normal to medical oversight.

The International Definition of a Midwife⁴ states that:

A midwife is a person who has successfully completed the prescribed course of studies in midwifery and has acquired the requisite qualifications to be registered and/or licensed to practice midwifery. She must be able to give the necessary supervision, care and advice to women during pregnancy, labor and postpartum period, to conduct deliveries on her own responsibility, and to care for the newborn and the infant. This care includes preventive measures, the detection of abnormal conditions in mother and child, the procurement of medical assistance, and the execution of emergency measures in the absence of medical help. She has an important task in counseling and education, not only for patients, but also within the family and community.... She may practice in hospitals, clinics, health units, Domiciliary conditions or any other service.⁵

Within the midwifery care model, levels of training and styles of service to the childbearing woman have developed. As birth became more medicalized and moved out of the home, a new subspecialty to midwifery care developed — the "doula" and the "childbirth assistant."

The "doula" is a woman, usually experienced in childbirth herself, who specializes in the emotional-care component of midwifery — the component that suffered most when birth left the home. The doula provides continuous emotional support, praise, physical-comfort measures, and advocacy to the laboring women and her husband/family. She is highly trained in the non-pharmacological methods of pain control, i.e., relaxation and breathing techniques, use of massage, position changes, heat, cold, and the use of water therapy. Her job is best described as one who "mothers the mother," or as one father put it, using industry jargon, the doula provides, "just-in-time" childbirth education. Doulas do not deliver babies. They perform no clinical tasks, but are present exclusively to provide non-clinical support. Women planning hospital birth are now hiring doulas in record numbers. Studies consistently show that the presence of a doula at births reduces the length of labors, the use of drugs, and the need for cesarean sections. Women breastfeed their babies more easily and bond more readily with their infants. Many couples also report greater marital harmony after their doula attended births.⁶ These results come because women experience far less stress in labor. This, in turn, allows their labors to progress normally as God intended.

The Certified Labor Assistant (CLA) or Certified Childbirth Assistant (CCA) is a doula with a broader scope of service and greater knowledge of the birth process. She not only assists the mother in the emotional and physical support as previously mentioned, but is also trained to use the "simple technologies,"⁷ i.e., watch, fetescope, thermometers, and blood pressure cuffs, etc. She has a "practiced ear for the baby and an experienced eye for the mother's physical well-being."⁸ And like the doula, the labor assistant does not actually catch the baby, but is able to assist with support during the delivery. The childbirth assistant is often hired by women who want to safely labor at home before moving to the hospital for the actual delivery. A woman with complications often chooses the labor assistant because of her understanding of medical terminology and procedures.

The midwifery model subspecialties of doula and labor assistant work well as adjuncts to the fully trained midwife, of which there are basically two categories — the traditional midwife and the certified nurse midwife.

Traditional midwives specialize in attending births in the home. They are either trained by apprenticing with an older, experienced midwife, or they receive their training in a combination of independent study, apprenticeship, or enrollment in a direct entry school of midwifery (as opposed to a nursing school of midwifery). Some traditional midwives seek certification as a Certified Professional Midwife (CPM), a status provided by the North American Registry of Midwives (NARM), or are licensed by their state. Not all traditional midwives seek licensure or certification. Traditional midwives strongly emphasize the emotional component and continuity of care component of the midwifery model. Because they do home visits, their care also tends to be very personalized. Most are qualified to fully function in the scope defined by the The International Definition of a Midwife. Traditional midwives are usually independent of physician oversight, though they often work cooperatively with sympathetic physicians or require their mothers to seek out prenatal care with a doctor who is then available should medical transfer be necessary. Many of them are free from the constraints of medical malpractice insurance carriers who, some have charged, tend to impose a defensive, standardized, fear-based practice style on physicians and some Certified Nurse Midwife Practices.⁹

Certified Nurse Midwives (CNMs) are registered nurses who specialize in a graduate program of midwifery. They usually practice only in clinics, under the supervision of physicians, and often in special midwife units within the hospital. They have direct access to medical diagnostic testing like ultrasounds and lab work. Although a few states allow CNMs to assist at home births, most do not. Some of the finest CNM practices offer the emotional component of doula care in addition to their clinical management of birth. Unfortunately, because of the constraints of heavy patient load and health insurance carriers, many CNMs function similarly to the physician in the clinic and hospital setting, i.e., rotating midwives at clinic visits, midwives managing more than one labor at a time, midwives coming in and out of the labor room and/or appearing only for the delivery.

Unfortunately, such management styles in nurse midwife practices keep these midwives from functioning in the full midwifery care model in the area of continuity of care for each patient. The doula's role here is particularly helpful to the CNM by providing to their patients the continuous emotional support a busy practice may prevent them from personally giving.

My daughter Charis' midwifery practice suffers under some of these constraints, so this practice encourages their patients to use doulas. However, the helpers Charis enjoyed at her birth where also able to serve her in the tradition of the "office of the Hebrew midwife." This Biblical model of midwifery includes the service levels of today's midwifery model, but in its fundamental presuppositions, transcends them. Sadly, most midwifery care today suffers under the curse of a secular worldview and a rampant pagan, New Age humanism hostile to Christianity. These New Age-influenced midwives are ignorant of their profession's Biblical origin. Scripture clearly claims historical ownership of midwifery care.

God, in his gracious mercy, did not leave women bereft in childbirth. Eve did indeed suffer a curse at the fall, "In sorrow shall thy bring forth children" (Gen. 3:16). But accompanying that curse came the promise that the woman's seed would crush the head of the serpent. As salvation history unfolded, God provided Israelite women the "Hebrew midwife." The Hebrew word for this birth companion is "Yalad," a word meaning, "to travail, to assist or attend as a midwife, to help to bring forth, to labor, to birth." God equipped a group of women to minister his comfort during pregnancy and childbirth."

Blessed be God, even the Father of our Lord Jesus Christ, the Father of mercies, and the God of all comfort; Who comforteth us in all our tribulation, that we may be able to comfort them which are in any trouble, by the comfort wherewith we ourselves are comforted of God" (1 Cor. 1:3, 4). The "Yalad" identifies so closely with the laboring woman that she can be said to travail along with her. And like the Apostle Paul's feeling for his Galatian converts, the yalad intercedes in heartfelt prayer for the mother. "My little children, of whom I travail in birth again, until Christ be formed in you" (Gal. 4:19).

Scripture records several references to the presence of midwives and their attendance at births (Gen. 4:1; 35:17; 38:27-3; Ex. 1:15-21; 1 Sam. 4:19-22). "The complicated births recorded in Scripture and attended by midwives are only a few of the thousands recorded in Scripture that most likely were normal births. The sections of Scripture that list them are extensive and quite boring to read. Most people skip over the "begats" of such passages as 1 Chr. 1:9-44. These are all babies who probably had uncomplicated, normal births because we do know that the babies lived. And the accounts of numbering in the desert attest to the fact of hundreds of thousands of births in tents attended by midwives."¹⁰

The most instructive reference to midwives is that of Exodus 1:15-21:

And the king of Egypt spake to the Hebrew midwives, of which the name of the one was Shiphrah, and the name of the other Puah: And he said, When ye do the office of a midwife to the Hebrew women, and see them upon the stools; if it be a son, then ye shall kill him: but if it be a daughter, then she shall live. But the midwives feared God, and did not as the king of Egypt commanded them, but saved the men children alive. And the king of Egypt called for the midwives, and said unto them, Why have ye done this thing, and have saved the men children alive? And the midwives said unto Pharaoh, Because the Hebrew women are not as the Egyptian women; for they are lively, and are delivered ere the midwives come in unto them. Therefore God dealt well with the midwives: and the people multiplied, and waxed very mighty. And it came to pass, because the midwives feared God, that he made them houses.

The Biblical office of midwife mirrors the midwifery care model in practical service and levels of care. A closer look at the Exodus passage reveals several keys to understanding this Biblical office, i.e., the significance of being "Hebrew," the meaning of the midwives' names, the Hebrew word for "see," the midwives' fear of God and their resulting civil disobedience, and the houses God established for the midwives.

"He spoke to the Hebrew midwives." "The word 'Hebrew' comes from the Aramaic word 'ayver,' meaning 'apart' or 'other side.' The patriarch Abraham was called 'haviri' because 'he was on one side even though everyone else was on the other.' Abraham did this because he sensed that what God demanded of him required that he think and act differently."¹¹ Midwives in the distinctively Hebrew tradition see themselves, above all, as part of the covenant, holy and set apart for service to the King of kings, faithfully obeying the commandment to love the Lord their God and their neighbor as themselves. And they seek to think and act differently from their secular counterparts.¹² As part of the covenant of Abraham, these midwives bind themselves to the other Christians they serve in a way that transcends a contractual relationship or even standard medical protocols or malpractice regulations. For example, a family may want to reduce their risk of a second unnecessary cesarean by taking personal responsibility for the birth process. If they chose to labor longer at home as disallowed by conventional medical protocols, this family could engage the services of a midwife in the Hebrew tradition. She would be willing to assume a higher level of risk than would be acceptable in the free enterprise model of medical care.¹³ Both parties respect the injunction not to go to law against one another (1 Cor.6:7).

"The name of the one was Shiphrah, and the name of the other Puah." Like most Hebrew names, they give insight into the nature and essence of their bearers. Shiphrah means to "garnish" from "shaphar" meaning "to glitter, to make fair, to have brilliancy, be goodly." Puah means, "pained, as a woman in travail, displayed, to glitter, to have brilliancy." Interestingly, the two midwives' names have similar meanings which reflect their duties and character. Using their names as an example of their calling, midwives of the Hebrew tradition are ordained to serve "in the midst of a crooked and perverse nation, among whom ye shine as lights in the world; holding forth the word of life" (Phil. 2:15). These midwives view their service to unbelievers as a tool that God uses to gather his elect.

"When ye . . . see them upon the stools." Shiphrah and Puah did shine as lights in their test before Pharaoh. He ordered them to "see" the Hebrew women "upon the stools." "This passage holds a hidden description of a midwife's responsibility. The word raah, translated as 'see' is a gem of many facets."¹⁴ Its rather lengthy meaning is "'to advise, approve, behold, consider, discern, make to enjoy, have experience, gaze, take heed, look on, be near, perceive, present, provide, regard, and have respect.' Each of its numerous applications represents a specific skill required of a godly midwife. Each skill gained is a facet through which the love of Christ might be refracted and magnified in a midwife's ministry."¹⁵

"If it be a son, then ye shall kill him." After being ordered to see the women upon the stools, Shiphrah and Puah were ordered to kill the males by what would have amounted to partial-birth abortion. Their civil disobedience provides a courageous witness for all Christians. The "midwives refused to destroy the male infants of the Hebrew women, even though disobedience to the Pharaoh could cost the midwives their lives. By this action God established that a midwife's duty is to do no harm, regardless of the possible personal or political consequences. The Hebrew midwife must above all things, fear God."¹⁶ Because they risked their very lives to protect the Hebrew male children, God holds them up as a righteous example. God calls godly midwives in today's world to stand against the death practices rampant in obstetrics: abortifaciant contraceptives, in vitro fertilization, cloning, fetal experimentation, and abortion.

"He made them houses." One of the typifying marks of a midwife functioning in the Hebrew tradition is blessing on her household. Her own family is an example of obedience to Biblical law and mirrors the peaceable fruit of righteousness to those she serves. God often calls women to the office of midwife either, for a season, before they marry or after their own families are well established and their children are maturing. And just as the older women are commanded in Titus 2:4, 5 a Biblical midwife teaches the younger woman to respect their husbands, train their children and order their homes aright.

The Bible's use of the word "doulos" is also instructive to our full understanding of the office of the Hebrew midwife. As mentioned, this Greek word is the origin of the word used today to describe the midwifery sub-specialty of a doula. "Doulos" is found throughout the New Testament (Rom.1:1; 1 Cor.7:22; Jas. 1:1,2; Peter 1:1; Gal. 1:10; 4:1, 4:7; 2 Tim. 2:24; Tit. 1:1; Jude 1). Strong's defines doulos as "a slave, bondsman, a servant, attendant; one who gives himself up to another's will, devoted to another to the disregard of one's own interests, and those whose service is used by Christ in extending and advancing His cause among men."

The very personal work of a doula includes using a servant's tools. "Absorbent linens are high on the [midwives] list, paper towels, menstrual pads, diapers, plastic trash bags, and other containers for the wet and wild work of childbearing. These tools of the trade are not the things of a sophisticated medical school curriculum."¹⁷ And these are the unglamorous tools of the trade of a humble midwife. "If I then, your Lord and Master, have washed your feet; ye also ought to wash one another's feet" (Jn. 13:14).

Like the Hebrews, Christian women are called to be set apart. And when expecting a baby, Christian women should be encouraged to take up God's provision for their comfort and care: service by devout women trained in the tradition of the Hebrew midwife. For some women this may mean finding a righteous doula, or childbirth assistant to accompany them during a CNM or physician-managed hospital birth. Other women will find a godly Certified Nurse Midwife, with or without the help of a doula, to minister to them throughout their labor and birth. And for others it will mean seeking out a godly traditional midwife to manage their pre-natal, birth, and post partum care in their own homes.

The Biblical pattern for midwifery is this: God has chosen by his sovereign grace to call some women to the Hebrew office of midwife. He has gifted them with the heart of a servant to care for women in the travail of childbirth. He has imparted to them the ability to be present and "see" the laboring mother in all her vulnerability. This is our merciful God's provision through the seed of the woman to overcome the curse of Eve. May you, your wives, or your grown children enjoy his provision as the first of mine already has!

Let this mind be in you, which was also in Christ Jesus: Who, being in the form of God, thought it not robbery to be equal with God: But made himself of no reputation, and took upon him the form of a servant (Phil. 2:5-7).

1. The Goodly Art of Orifice Maintenance,” by Faith Gibson, RN, CRM, domicialary midwife, originally published in the newsletter of the Midwives Association of North America, December 24, 1994.
2. “The Mother-Friendly Childbirth Initiative,” Coalition for Improving Maternity Services (CIMS), 1996, ASPO/Lamaze, Washington, D. C.
3. Heart and Hands by Elizabeth Davis, Celestial Arts, Berkeley, CA, 1997.
4. As defined by the International Confederation of Midwives and the International Federation of Gynecologists and Obstetricians, 1972.
5. Myles Textbook for Midwives, edited by V. Ruth Bennett and Linda K. Brown, Churchill Livingstone, Edinburgh, England, 1993.
6. “Maternal Assistance and Support in Labor: Father, Nurse, Midwife, or Doula?” Marshall Klaus, John Kennell, et al. Clinical Consultations in Obstetrics and Gynecology, December, 1992, 221-217.
7. “The Religious Practitioner of Midwifery,” Mennonite Order of Maternal Services, by Faith Gibson, www.goodnews.net.
8. “The Goodly Art of Orifice Maintenance,” by Faith Gibson, RN, CRM, domicialary midwife, originally published in the newsletter of the Midwives Association of North America, December 24, 1994, 4.
9. Heart and Hands by Elizabeth Davis, Celestial Arts, Berkeley, CA, 1997.
10. “Midwifery Institute of America” Lesson Book, by Mary Burleson, Midwife, Selmer, T N , 1998.
11. “Vows for the Office of Midwife,” by Faith Gibson, www.goodnews.net 2.
12. ibid, 2.
13. “The Religious Practitioner of Midwifery,” Mennonite Order of Maternal Services, by Faith Gibson, www.goodnews.net, 4.
14. “Advanced Training Institute of America,” Midwifery Course, Preface.
15. ibid.
16. “Vows for the Office of Midwife,” by Faith Gibson, 1, www.goodnews.net
17. “The Goodly Art of Orifice Maintenance,” by Faith Gibson, RN, CRM, domicialary midwife, originally published in the newsletter of the Midwives Association of North America, December 24, 1994, 4.