Hands on. Hands off. Core Principles for Midwifery and Midwifing the Inner Life of Wimyn

Sister MorningStar has dedicated a lifetime to the preservation of instinctual birth among native people, having helped thousands ofwomen find empowerment through this transformational experience. In this piece, she gives us a glimpse of the intimate bond she forms with the women she works with, highlights the importance of preserving traditional midwifery skills, and explores the politics that surround this sacred art today.

This article is scheduled for publication in the anniversary issue of Midwifery Today and is published here with permission from Sister MorningStar.

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“Do you have any other questions or comments?” I ask. Silje floats in her boat on the southern shore of Norway, and I pause in admiration from my cozy rural library in Missouri.  I am a Skype Mydwyfe to this gorgeous woman with her rosy cheeks and new mother enthusiasm. Silje easily moves in and out of yoga poses while showing me her growing baby. Her Cocker Spaniel companion nestles in to watch us.

“No, I don’t think so,” she beams. Silje is now 33 weeks. We met in Norway months ago when she discovered she was expecting her first baby.

“I have one,” I say. “What would your ideal birth look like? What would you be doing and who would be there and what would they be doing?”

At first she tells me things that have to do with safety and I can hear the anxiousness in her voice. She begins to describe medical back up plans “in case the midwives say that transport is necessary.” I listen. Then, I ask again. “Assuming all is well, since it is…”

She relaxes. Her head drops back and her eyes close and she starts describing the scene. She is in the tub and her dog and her beloved are near. The midwives are not mentioned. She ultimately births in a strong yogic squat in her meditation room with her partner receiving the baby. They are happy and the new baby and dog are nestled in bed again, just as they are now only with the baby on the outside.

“Actually,” she continues, “I want my baby to be born into a community of strong wimyn. Wimyn that know me. My community. The midwives are not my community. I have a friend who is calm and caring. I want my baby to be born into my community of strong wimyn.” We talk some more about how to make that possible and what this powerful circle of wimyn might be doing. Silje likes the idea that they would sing or chant to welcome her baby with first sounds from loving strong wimyn voices.

Listening to a mother is the most important skill of midwifery. Asking her questions is the second most important. Third is making unrushed time together in nature with a bit of privacy so the important matters can be discussed. And everything matters to a pregnant womyn — her health, her dreams, her fears, her stresses, her food, her relationships, her resources, her plans, her shelter, her sleep, her ideal birth, how her mother was born and how she was born. Too much of what matters to a mother has become rushed or eliminated in our modern health care system, including within midwifery education and practice. Everything that has become a diagnostic evaluator with a number that fits in a box, has taken the place of what matters most to wimyn who have become mothers. These numbers which create arbitrary barriers to basic human rights now take up most of the time in the prenatal visit, the labor and birth room. The court room.

Village midwives of antiquity knew the wimyn they served by name and walked to the well with them. They knew what their mothers ate, where they slept, what kind of relationship they had with their own mothers, husbands, other children and with themselves. They knew of accidents, injuries, sicknesses and heart breaks. They didn’t have to ask. They were apart of the life of the community they served.

We must visit the home and walk the block or land and sit at their table in order to know what kind of life a mother is living and what is possible for her to grow and care for herself and her baby. To help recreate a sense of belonging, I have been teaching the basics of the prenatal village in countries around the world. We can return birth to a womyn’s local community by some simple steps. Womyn gathering together and sharing powerful birth stories, listening and talking to the baby, asking about a mother’s worries, fears as well as ideals for her birth, walking in nature or howling at the moon and feasting together is something the Village Prenatal can do that a professional prenatal visit cannot do: return the power of birth to the people. The human spirit as well as the inner life of wimyn thrive with rituals such as dancing, drumming, singing, story telling, eating together, lighting candles, making prayers, sharing wisdom and creating a sense of deep and lasting belonging. Babies need to be born into the arms of their mothers and mothers need the loving arms of a community to hold them in new motherhood. The Prenatal Village becomes the Elephant Circle holding sacred space at birth and the power stories become word medicine to give hope to a new generation of birthing mothers.

The more hands on during the prenatal journey, the more hands off is possible at birth. The countless visits and phones sessions necessary for a mother to build trust and ask sensitive questions and open her body and mind and feelings require conscious and consistent hands on care. The power of instinctual birth and the irreplaceable moments of mother-baby attachment during the “golden hours” following birth require hands off. Successful breastfeeding, bonding and becoming a mother during the infamous 40 days of lying in require hands on. Hands on. Hands off. Hands on. That is the key to supporting the inner life of wimyn during childbirth.

Individualization of care is a foundational cornerstone of midwifery care. It takes a very engaged, vital and caring mind to assimilate the multifarious impressions and information provided by a pregnant or birthing or nursing mother. Unique to every mother. Distinct at every visit. The ever changing and increasing pieces of information take a 1000 eyes and a vocational as opposed to professional heart to assess and midwife. Attaining the vital signs is the easiest part.

Mastering the rudimentary and repetitive skills of taking blood pressure, pulse, weight, uterine height, fetal heart tones, blood and urine analysis and dating for comparison can be taught to the simplest of minds. In fact, machines now do most of it for most wimyn. Creating a “safe standard” for these vital signs, whether in pregnancy or labor, insures the continued use of simple minds. Reducing the dynamics of physiological birth to acceptable patterns and norms eliminates the need for critical thinking. Machines are actually better equipped to make such decisions with less error. As Michael Odent[1] has warned, we are fast approaching the time when there will be little evidence to contradict the conclusion that most babies can be saved with scheduled cesareans at 39 weeks. Without the wisdom of what my Cherokee people and most native cultures call, “Unto the seventh generation,” short sighted people with power will choose short sighted solutions that affect the masses for a very, very long time.

I like to make frequent home visits and I also like visits at my home where I can make a cup of tea and we can walk along the creek line and see how we both do in our different environments. If a mother has had several babies and is a busy mennonite mother with summer gardens, we may go 4 or 5 weeks between visits, trusting one another. If the mother is expecting her first baby and has worries or feels poorly in body, mind or soul we might visit every week. We always make a plan and agreements and if necessary, we talk between visits to adjust the plan. What good is a plan if it is not working? Prenatal care is the care a mother gives herself between visits with her midwife.

I have never used a Doppler. It may sound old fashioned but I value hands on skills. I have watched my colleagues lose their natural capacity both to hear baby heart sounds and placental sounds and amniotic fluid sounds as well as lose confidence in what they do hear. I love listening with fetoscopes and with pinards and with my ear. I love teaching mothers and fathers and siblings how to listen and connect with their babies in this natural way. Listening tells a quality and distinction that a number acquired with a machine can never tell.

I watch for nature deficit disorder and city dweller syndrome in mothers who feel awkward in their bodies or shy to pee in front of others. I encourage mothers to walk in nature and float or soak in water and take time alone as well as time with like minded souls. One out of three wimyn are adult survivors of childhood incest or sexual abuse, misuse or amusement. Survivors carry the marks of their early wounds in their posture, dress, intimate relations and dreams. Midwives are meant to be gate keepers for healing. If harm was done going in, healing can often occur when baby comes out. Addressing the delicate issues of sensual and sexual assault to wimyn’s bodies (which can be first experienced in childbirth even if they escaped abuse in childhood) is another reason we need unrushed and private time with wimyn.  I often wonder why we insist on putting things up and in during pregnancy and birth when we want things to come down and out? More money in health care is made off of wimyn’s bodies than any other area of medicine. Most of that is acquired during the reproductive years. Hospital administrations know that to keep the doors open, the obstetric wards must be full.

Books can and are written on the deviations in pregnancy and birth and the complications of both. It is sometimes valuable to know as much as we can about problems and what to do, especially in urgencies. But midwives were originally the experts in normal, not abnormal. Fear, pathology and managing birth has begun to rob a mother and a midwife of knowing normal and all its variations. Interestingly and maybe out of necessity, midwives are now more skilled and have gained more confidence in caring for Vaginal Births after a Cesarean, which is not normal, than breech and twins, which are normal. Quite frankly, death is also a normal process as surely as birth and that too has become a forbidden area of knowledge, experience and acceptance in childbirth for midwives.

There is no greater gift to the soul life of a midwife than to have regular opportunity to observe birth without being in the role of a professional with all its responsibility. To observe the power and inevitable purpose and wonder of birth renews the steadfast fact and faith that birth works. Two brilliant quotes always settle my mind when worrisome yet concerned legislators or citizens question me during the trainings I offer in Basic Disaster Birth Support, Emer-Gently education or Physiological Resuscitation.[2] One is by a brilliant colleague, Pat Edmonds, who says, “You don’t have to be in a birth room to be at a birth.” And, Dr. Gregory White, who, upon being asked how to get a baby out if, if, if, responded, “How do you keep them in?”

Despite the age of information, mothers tell me they prefer to read birth stories. I teach them how to disengage well meaning family and friends from telling them birth horror stories.  As mothers we must learn how to protect our womb baby with positive thoughts and feelings. Worry wont help and it is so harmful to worry a mother. She already knows she is a mystery with many possibilities. Building her confidence in her own instincts is her wisest path both for birth and a lifetime of motherhood. It is the wisest path for a midwife as well.

I have watched mothers with no training other than their instincts, crawl into a dark corner to get privacy, hike a leg to realign an asynclitic baby, flip or jump up to dislodge a stuck baby, roll to reposition a posterior baby, throw back their head and open their mouth when their baby is coming to prevent pushing too hard or fast, pull out their own placentas when they are tired of it hanging around, chew on cords (which prevents excessive blood loss), resuscitate their own babies and suckle other children to bring in their milk.

Many factors shape maternal-infant health and nothing matters more than nutrition. Nutrition is anything we metabolize, not just the food we eat. We metabolize thought, feeling, environmental toxins, fear and joy. That is why everything matters to a pregnant mother, including the things she thinks about. I serve wimyn who are carnivores, herbivores, vegans, many with special dietary needs and mothers with few resources. We can follow the USDA, WHO or Brewer food guides for teaching a mother how to grow a healthy baby but her budget, cravings, traditions, beliefs, terrain and genetics will influence her choices far more than something she learns with her head. The first winter I was working with my local mennonite community I learned a little something new regarding how folks who live close to the earth think about food. Mary was pale and weak with her 7th child. I was encouraging and recommended more rest, help from other family members and eating more high protein, high calorie food more frequently, emphasizing fresh leafy greens. The husband stood up, peered out the window at the several feet of snow that had recently fallen and said, “Well now, green food wouldn’t be growing here about this time.” We learned to grow sprouts in that window sill.

I talk about eating like the deer and how to nibble all day long, just a little bit, until the body finds its balance. We talk about what grows locally and naturally and how to build balance of calorie input with calorie output. We drink to thirst and salt to taste. There is no formula that will work for all wimyn. It is critical to know the life of the mother. Does she sit at a desk or garden in the sun? Is it her first baby or her sixth? Is she happy or sad? Does she have a budget for supplements or does every penny go to providing shelter? Is she urban or rural, highland or lowland, tropical or Icelandic, native or ethnically displaced? The humble villagers in Mexico eat beans and nopal cactus and avocados and mango and grow healthy babies for pennies. Sometimes the poor are richer than the rich. When I travel the world and hear that a certain area has mothers who are undernourished and prematurity is rising, I look around to see if there are any wild mammals. If there are mammals growing healthy offspring, we can too. We are animals and we sometimes forget how to use our instincts.

What about muscle knowledge? We learn the ways of our people and how to adapt to our environment during the womb and pre-verbal period. What we learn in those early stages of development is called muscle knowledge. We don’t know when or how we know something. We think everyone does, or should. Once, in the 1990s, I was walking on a village path in Mexico along side a mother with her baby in rebozo, her toddler by the hand and her 8 year old daughter by her side, I asked, “How do you learn to carry your baby in cloth with confidence? Can you teach me so I can teach my mothers back in the states?” She looked puzzled, swung the rebozo off her back into the air, baby inside, swung it back into place tying it across her chest all in one fluid motion. “!No se caye!” she exclaimed. She won’t fall! She handed the rebozo and baby to the 8 year old who promptly did the same, saying, “!No se caye!” The mother affirmed as they walked away from me, “All wimyn know how to carry their babies.” It was that simple.

Whether muscle knowledge or raw instinct, pregnant mothers are the most intelligent and instinctual creatures alive on the planet. Their senses are more acute. The superiority and the complexity of their biological functions, especially during labor and the moment of birth, are so rapid-fire precision that to interrupt them, distract them, scare them, undermine them, even to help them, is to submit them to danger. Sometimes grave danger. Interrupting the flow of the old brain at a time when millions of years of biology are working to preserve lives, mother and child, is more than rude. It is dangerous. It is becoming defined by the Geneva courts as “Obstetric Violence in defense of human rights in childbirth.”[3] And none too soon.

If we go into labor with a healthy mother and baby that is generally what we come out with. Walking with wimyn to the well was the way of midwifery of old. Modern midwives must find an equally engaging way to increase the hands on time during the prenatal period so that when it comes time for birth, we can be more hands off. We can aid the intelligence of biology and provide the critical needs of privacy, warmth and calm companionship. Unrushed and uninterrupted at birth, a mother and baby will become locked in the infamous “newborn gaze.” Skin to skin, they will bond for life. The imprint and blueprint for life long health and happiness are laid in those irreplaceable first moments and hours. Calm companionship, help cleaning up, providing food, sharing her triumph, organizing others, listening to her story and needs and promising to come back are the hands-on actions that allow us to be hands-off when “doing something” causes more harm than good.[4]

It is 2016 and there is so much wrong with the interfacing and transport needs of out of hospital birthing mothers and midwives that I don’t know where to start. Or stop. If we can create a medical response structure in our society for automobile and air travel catastrophes; if we can help save lives of crash victims with compassion and immediate care, then, we can receive a mother in need and use that same medical expertise to respond to emergencies in childbirth without scrutinizing, shaming or threatening her. If she isn’t walking in the door and doesn’t have an emergency, we can learn to respect her human rights, autonomy,  privacy and leave her alone. Yes, we can.

What is human rights and what is human? As we move closer to human cloning and carbon based robots and test tube babies grown with altered genetic structures, who gets to decide who has human rights and who is human? Even gender tolerance is a necessary skill of the modern midwife who may have sentient beings under her care who self identify from hundreds of gender identities. This is the new world of hormone, bio-chemistry, physiologic and anatomic specialization where what was once mysterious, hidden, unseen and misunderstood is revealed. May the human spirit, so capable of compassion as well as cruelty, mature along with a maturing techno world that has infiltrated the womb as surely as it now resides in our minds and homes.

It is tragic when legitimizing something as common as women helping women reduces the number of midwives available to mothers. State after state and country after country we are told that regulation and licensure creates more birth options for mothers. In fact, it reduces their options. I have watched experienced skilled midwives stop attending breech, twins, grand multiparas, early babies, late babies and more. The loss to mothers and midwives is great but the greater tragedy is the loss of valuable skills and knowledge that once was naturally preserved and passed down via birth. It is possible that the desire for public health is innocent but it is equally possible that power, money and the control of wimyn’s bodies is at the root of making a few legal and most outlaws. No wonder underground midwives and mothers groan when they hear of another “legal” state or country and dive further underground.

Today I sit in the home of Bailey Campanini, daughter of Cheryl Campanini whose story is preserved in The Power of Women.[5] Bailey is expecting her first child. She lies down on the plush multi-colored rug and excitedly we begin to listen for the tiny sounds of a tiny heart and working placenta with my fetoscope. Darin, her husband, sits near by, crouching like a happy tiger. Their two miniature dachshunds, Carla and Liz, nestle in — one laying on Bailey’s legs and the other at her head. The cat prowls in wider circles. It is a family affair.

I have become like Dona Cuca who answered me decades ago when asked the question, “Dona Cuca, how many babies have you midwifed?”

“Lord knows!”, she exclaimed. “One grows up and along comes another.”

Helpful Checklist

After some trust is built and agreements are made by being unrushed together, assessing the well being of a mother and baby becomes a fun and meaningful journey together.

Some Hands on assessments for initial and ongoing well being I use are:

  • general vitality, cheerfulness
  • freedom of movement, gait, pelvis
  • shape and color and whites of eyes
  • tone and texture of skin
  • markings on skin
  • ease of breath: sitting, walking, stairs, bending forward
  • ease in swallowing
  • color of tongue and markings
  • ease of hearing
  • clarity of voice
  • eye contact
  • strength in arms and legs
  • flexibility of joints in fingers and hands and ankles and feet
  • symmetry going into and out of a squat
  • spinal symmetry and flexibility on all fours
  • heart and lung sounds
  • pulses in wrist, groin and feet
  • nail beds in hands and feet, capillary refill
  • reflexes in elbows, knees, ankles
  • abdominal tone/comfort
  • breast shape or surgeries or implants
  • color and smell of urine
  • frequency and consistency of stools
  • appetite — diet review, cravings, aversions
  • sleep and nap patterns
  • discharges: quality, quantity and odor from nipples or yoni
  • reproductive narrative — herstory of moon flow, sexual life, previous pregnancies
  • dating for estimated due date based on menstrual herstory, accounting for parity, length of cycles, previous births, breastfeeding and maternal lineage
  • relationships — mother, grandmother, partner, children, siblings, friends, co workers
  • baby — growth, position, heart rhythms, response to speaking other languages
  • placenta — sounds, position
  • dreams — sleep side and wake side
  • resources — financial, emotional, spiritual, internal and external
  • hardest thing they have experienced and how they dealt with it
  • fear, desires, concerns, ideals
  • ideal birth
  • I notice if we can laugh and cry together


[1] Odent, M. (2013) Childbirth and the Future of Homo Sapiens. Pinter and Martin Ltd.

[2] sistermorningstar.com

[3] humanrightsinchildbirth.org

[4]I have found Disaster to be an equalizer. That is the gift of a disaster. It opens our minds to options we reject otherwise and to working as a team with folks we ordinarily won’t be with to pee in the same toilet. Subjects such as physio/psycho/social/spiritual midwifery, instinctual birth, primate resuscitation and use of placenta for avoiding blood loss is generally unwelcome by excessively educated health care providers of all sorts. If the subject is disaster, natural or man-made, their minds open and learning begins. It is an odd way to preserve critical knowledge but I must admit, I am grateful for the opportunity.

[5] Sister MorningStar. The Power of Women. MotherBabyPress.com 2011

This article was originally published in Midwifery Today and is republished here with permission from Sister Morningstar.

Sister MorningStar has dedicated a lifetime to the preservation of instinctual birth among native people. Experientially, she was raised in the Ozark Mountains within the influence of Cherokee traditions. She birthed her own daughters at home and has helped thousands of other women find empowerment through instinctual birth. Politically, she has served on state, national and international boards helping to oversee the development of midwifery certification programs. She serves on the CASA International Advisory Board helping to oversee the continued stability of Mexico’s first accredited Midwifery School and Maternity Hospital. She is the founder of a spiritual retreat center and author of books related to instinctual and spiritual living. She lives as a Cherokee Hermitess and Catholic Mystic in the Ozark Mountains of Missouri. To contact Sister MorningStar, visit www.sistermorningstar.com.