.png)
Three Years of Learning From Midwives. One Pregnancy to Put It All to the Test.
By Ana Gutiérrez, Communications Lead, International Confederation of Midwives
Three years ago, if you had asked me what a midwife did, I would have given you a very confident—and very wrong—answer.
I would have described midwives as something like community health workers who focused on women, mostly in rural and underserved communities. I thought their role began and ended with birth.
Oh, how wrong I was.
That blind spot feels particularly humbling given my background. I went to medical school, worked within the Mexican health system and completed a master’s degree in global health. I thought I understood health systems. Yet somehow, I had made it through all of that without really understanding what a midwife was.
That changed when I applied to work at the International Confederation of Midwives (ICM). The research I did before my interview overturned what I thought I knew.
For years, part of me had dreamed of becoming an obstetrician-gynaecologist. I had imagined providing care that was respectful, relationship-based, grounded in physiology and centred on women’s choices. As I learned more about midwifery, I realised that the care I had imagined was, in many ways, midwifery care.
I quickly learned that midwives are educated, regulated and accountable health professionals who care for women across their sexual and reproductive lives. They are defenders of gender equality, champions of sexual and reproductive health and rights, and experts in care that centres the woman: her physiology, circumstances, choices and needs.
Working at ICM has since changed more than my understanding of one profession. It has changed what I expect from healthcare.
I felt that shift while trying to conceive, when health professionals sometimes minimised my concerns or dismissed my worries. Being surrounded by people who embodied woman-centred care gave me the language to recognise what was happening. I knew that being listened to was not a nice extra. It was part of good healthcare.
Now, I am pregnant. Everything I have learned is shaping how I understand risk, explore my options and prepare for birth. None of it is theoretical anymore.
Pregnancy is often treated like a nine-month risk assessment. Eat this, but not that. Exercise, but not too much. Move, but carefully. Suddenly, the pregnant woman is treated like a delicate flower—or a disaster waiting to happen.
I remember having dinner with a pregnant friend whose husband worried about everything she ate. Even a sandwich containing a single lettuce leaf prompted concern: had it been washed properly? Was it safe? A piece of pork led to anxious checking that it had been cooked through (as though safely cooked meat were a pregnancy-specific requirement rather than ordinary food hygiene).
I understood that he wanted to protect his wife and baby. But I found myself wondering: what was the actual risk? What did the evidence say? At what point had sensible caution become an attempt to control every possible outcome?
Another couple I know stopped making plans and stayed home for the entire month before the due date, just in case labour began. Again, the intention was understandable. But it made me think about how easily pregnancy can become an exercise in eliminating uncertainty, and how quickly a woman’s life can begin shrinking around every possible risk.
Working with midwives taught me to begin somewhere else.
Pregnancy is a physiological process, not an illness. Most pregnancies progress safely when women are healthy, supported and able to access high-quality care. Complications can and do happen, and skilled professionals must be able to identify and respond to them. But the possibility of complications does not mean every pregnancy should be lived as a nine-month emergency.
Understanding this has not made me reckless. It has made me proportionate. I attend my appointments, ask questions and follow medical advice. But I also look for evidence, put risks into context and resist allowing every uncertainty to become a catastrophe.
Perhaps the biggest shift has been in how I think about birth. I no longer see it as a medical process that occasionally happens naturally. I see it as a physiological process that sometimes needs medical support.
That difference sounds subtle. It changes everything.
One figure stayed with me: research shows that roughly 75% to 85% of all labors and births are low-risk and proceed without major complications. This means the vast majority of births require minimal medical intervention, allowing the natural physiological process to take place safely for both the mother and the baby.
Working with midwives also taught me something that can be forgotten in highly medicalised systems: women are not passive participants in birth. Our bodies have an extraordinary capacity to give birth, with physiology, instincts and signals of their own.
Not every birth will unfold without difficulty or intervention, and needing help is never a failure. But I want to enter labour trusting my body’s capacity, not assuming from the outset that it will fail me.
I want to listen to my gut, speak up when something feels wrong and notice when my body asks for movement, rest or a different position. Accepting professional care should not require handing over every decision. My care providers bring clinical expertise; I bring knowledge of my own body. Good care needs both.
Knowing that options exist is one thing, a very important one at that. Understanding them well enough to make a safe decision is what turns choice into autonomy.
Working with midwives has taught me that the pathway presented as standard by a health system is not necessarily the only one available. I am fortunate to live in a country where midwives are central to routine maternity care and will be my primary care providers if my pregnancy and birth remain uncomplicated.
However, Spain’s health system, like many others, is under pressure. When professionals are overworked and services stretched, appointments can feel rushed, continuity can be lost and care may not be as individualised as it should be—even when the people providing it are doing their best.
I have therefore taken the responsibility of exploring my options seriously. I am exploring not only where I give birth, but how: who will care for me, what options I will have during labour, how my preferences will be respected and what will happen if my needs change.
I also know that information is only part of the equation. Acting on that knowledge requires options, time, and money. ICM has given me knowledge, but I am privileged to have the ability to explore what I can do with it.
I still do not know what I will choose, but I feel comfortable knowing that whatever I decide will be grounded in evidence and clear information, and that decisions about my body and care ultimately rest with me.
I find it funny how people assume that, because I work with midwives, of course I will breastfeed. I also find it slightly surreal how early in pregnancy people begin asking about your breastfeeding goals, long before you even feel your baby, let alone have any idea how feeding will unfold.
I hope to breastfeed for long because I believe it is the best option for my baby and me. But if I have learned anything from working with midwives, it is that breastfeeding is not simply a decision followed by enough determination. Outcomes are shaped by the support surrounding a woman.
Successful breastfeeding should not be seen as a personal victory, nor should difficulties be treated as evidence that someone has failed. Breastfeeding requires time, skilled support, patience, rest, care and understanding. It requires maternity leave, supportive families, knowledgeable health professionals and workplaces that recognise feeding a baby as essential work.
Yet we live in systems that often expect women to recover from birth, care for and feed a newborn, and return to their previous lives as though nothing extraordinary has happened. Breastfeeding demands one of the resources our economic systems value most but rarely give new mothers enough of: time.
So, rather than simply hoping it will work, I am thinking about the support I may need. Who can help me? Where can I turn if it hurts or becomes difficult? How can I protect the time required to establish it?
And if it does not happen as I hope, I will try to remember that there may be many reasons—and not all of them will be about me.
My birth plan is currently less of a fixed plan and more of a well-informed collection of possibilities.
I am still exploring my options, keeping an open mind and trying to stay informed without becoming overwhelmed. I plan to take a birth preparation course with a group of midwives who inspire me. I am also thinking seriously about the support I may need after birth because I have learned that birth is not the finish line. It is the beginning of everything that comes next.
I do not know how my birth will unfold. The test is not whether I achieve a perfect physiological birth, avoid every intervention or follow everything I have learned.
The test is whether, whatever happens, I remain informed, respected and part of the decisions about my care, and whether I can meet the unexpected without interpreting it as failure.
That may be the most important lesson midwives have taught me: woman-centred care cannot guarantee a particular outcome, but it can protect a woman’s dignity and agency through uncertainty.
I know how privileged I am to have learned all of this through my work. But understanding your body, rights and options should not depend on being lucky enough to stumble across the right information or happen to work alongside midwives. Every woman should be able to access that knowledge as a routine part of her care.
Five years ago, I thought midwives existed somewhere at the edges of healthcare. Now I know they should be at its centre. And I hope they will remain at the centre of my pregnancy, my birth and everything that comes after.
.png)
