Midwifery Is Not Obstetrics: The Importance of Precise Maternity Care Language.

Abstract

Would you consider this recent use of the term obstetrics [in a JMWH article] instead of midwifery an opportunity to raise the consciousness of the midwifery community about the importance of more careful use of the 2 terms? Maybe if you already have something about this in your instructions for reviewers, it needs to be revisited. Would an editorial by you help everyone to be more aware of the need to define and explain the importance of differentiating the practice of midwifery from the practice of obstetrics? Midwifery is not obstetrics, and obstetrics is not midwifery. Both are needed but in ratio to the needs of the women and families we serve. Today we have an inverse ratio…Midwives are health care providers not medical care providers. Health care is not medical care. The Merriam-Webster dictionary defines obstetrics as “a branch of medical science that deals with pregnancy, childbirth, and the postpartum period.”2 While midwives often consider obstetrics to be part of what we do, using language specific to that discipline and profession can have negative consequences for midwifery. Referring to midwifery as obstetrics makes midwifery invisible in women's health care and fails to distinguish the differences between the 2 professions. Separate language is important in describing the distinct models of care, not only for professional dialogue, but also for women to make informed decisions about their health care provider options. Calling midwifery obstetrics reinforces the myth that midwives only provide pregnancy, birth, and postpartum care rather than reflecting the full scope of midwifery practice. The term obstetrics may imply medicalization of birth and normalize this as the standard of care. Using obstetrics and related terms as the standard language for maternity care, health care providers, and related concepts fails to include not only midwives, but also other professionals who provide maternity care, such as nurses, nurse practitioners, and family physicians. The JMWH Manuscript Preparation and Style Guide states “Obstetrics is a medical specialty. When referring to care provided by midwives and other providers who are not obstetricians, use midwifery care, the specific type of care (eg, prenatal, labor and birth, postpartum), or maternity care”; however, the language in the Journal has not always been consistent as Ernst notes. As I've become increasingly attuned to the distinction about word choices regarding maternity care and health care providers, I find myself assessing the use of obstetrics and related terms in manuscripts for JMWH to determine if the words being used are appropriate for the information being conveyed. As I have considered what the most precise language is for individual sentences, I've also had to contemplate the options for word choices. Table 1 presents suggestions for precise and inclusive language when discussing maternity care, maternity care providers, and related concepts. Of course, there are instances in which variations of obstetrics are used in JMWH. Our goal is to do so accurately, consistently, and judiciously. Language is important and influential. I request that the Journal stop using (and letting authors use) the term obstetric when talking about midwifery care. Obstetrics is what obstetricians do, midwifery is what midwives do, and maternity care is what we all do. We have to retract the language that physicians and the populace have inserted into the English language that normalizes obstetrics, thus making midwifery hidden, an “alternative.” Thank you to JMWH Managing Editor Brittany Swett, MPH, for her contributions to this editorial. I am also immensely grateful for her continual work to ensure word choices in the Journal are precise and consistent.