Charting the Course of Midwifery: Rethinking Translation of the Soul World for Medical Systems

When I had prenatal care in the 1990s, I was given my prenatal chart to bring home with me.  It was my responsibility to bring it back and forth.  Today, I can only imagine how many people would possibly leave theirs at home or lose them. Maybe my midwife only did it that way for a short time due to legal issues, but it was my chart with my information.  At 22, with little experience interfacing with medical models, I really didn’t understand the hierarchy involved with records and how radical this information sharing happened to be.

Coming from a home birth culture where there was little or no charting, I remember going to my first homebirth where midwives were charting.  I was thinking about how formal that seemed that they had this paper and were writing everything down on it consistently and how it was possibly a distraction.  I guess my judgements as a someone who had previous done unassisted births swirled around the encroachment of professionalization into the birth space. And yet, I also appreciated the care and patience that was provided.

As an apprentice, I found that charting was just us keeping track for the parents and for ourselves as birth time was the shape shifter.  It allowed us to see the forest through the trees and also keep information organized in one place on paper.  In fact, everyone was paper charting as electronic records weren’t a thing.  

As I became a midwife and a mentor I remember a particular conversation with a friend of mine about how she was having trouble with charting the “right way” as a student midwife.   As I listened to my friend, I heard her difficulty in keeping up with this process.  I mentioned it was a language in and of itself.  It was the language of translation from the soul world to the upper world.  Yet we also must think about what are we translating and for whom?  This is a big question and we tend to create a chart for professional considerations even more than for the person who is birthing these days.  It is true, good chart notes might be a lifeline to continuance in professional midwifery culture.  Yet, with awareness we can be medial scribes as we sit at the bottom of the labyrinth in the dirt and yet are able to plug into a potential translatable language to the medical systems and their thinking. We might even be translating for the birth giver themselves as they return to look back on this experience from the other side.

And then we are also looking at midwifery longevity in home birth culture because we can speak the language of the medical system.  And so sometimes the charting can be for us to show our competence.  Sometimes we chart for approval in case we interface with the medical community.  We are translating, but we also need to keep clear about how we do things and what is necessary and for whom.  

This week I have been thinking about the structures out there that frame assumptions in midwifery practices.  I was just talking to my apprentice about the power of our own charting yesterday.  We still do paper charts for visits and yet, this last year, I got electronic charting for easy access and better organization of labs and for … billing.  We are paper charting when we are with people face to face.  No electronics in the room unless we need to look something up or type a quick letter. 

Electronic charting is still new to me.  We discuss uploading labor notes instead of inputing them into the electronic system as it is easier.  However, the other day I just decided to enter the notes from a birth as I was trying to make it easier for my biller.  As I did, I realized how my chart that I share in a similar format with another midwife in my community didn’t transfer with the information framed how I wanted it to be.  There were smaller things which most wouldn’t think mattered like highlighting the cervix or automatic checkmarks for the newborn lists, or not having spaces for entering certain things I might value and want to track myself. I mean, I can just add the things I think are important to the notes section, right?  Why am I complaining?   

Charting is set up to frame what is important to meet the baseline of professional and medical systems.  This also frames and what students see and learn.  There may even be an ability to create new or different tabs for information, I don’t know.  But it got me thinking about standardization and efficiency changing what we see when we look at birth and newborns.  We then begin to frame normal around those systems and the assumptions of the medical stories become midwife stories.  

The structures affect the people living in them and the people living in them affect the structures.  The charting affects how we see and move with the things we do with birth just like birth affects the structures of how we chart.  We know this is a dialectical relationship.  We know this is storytelling birth.  Story is powerful.  We do need structures for us to reflect the language of the soul world so we can make sure it doesn’t get forgotten now or with generations to come.  

The medical story of birth has been powerful and although midwifery believes itself to be exempt, many of the home birth origins have also come from medicalized assumptions.  As we look to the stories that are created out of these assumptions, we begin to use birth language differently.  It is important to stay practicing in California for me.  I would like to continue attending births and allowing for smooth transitions for desired care and safety when needed and translating from the soul world to the upper world is quite useful.  

The hierarchy of charting systems and lack of interface is creating more and more distance between the personal experience and medical industrial systems, medical language, and thus reducing the potential for interpretation.  

So as I look to review my paper charts this week, I wonder how they have already framed my language or what I see around birth.  I wonder what I notice that my students will not notice and how I can prioritize what I see as our own interpretation of that space of the soul world in birth.  How do we go beyond the clinical observations to that of naming what we are learning from the birth experience itself.  Our storytelling matters greatly and so do the words that we continue to use.  I look forward to continuing to chart instinctual positions, the sounds and outer signs of progress, the various head circumferences and piecing together the puzzle of challenges or ease of descent.  I look forward to acknowledgement of what is said by the birth giver.  I look forward to remembering from the bottom up and not just the top down.  

The other day my student was setting up a chart and they went ahead and handed the chart to the client to fill out basic information themselves across the top of their chart.  Can you imagine?  The client touching the chart themselves in their own two hands?  This was not so radical a few years back!  I was so proud that they did this crossing of the line.  It wasn’t just the intake, but it was the main chart itself.  We have created some ethereal mystery of “the chart.”  We have come a long way from me taking responsibility of my one page of prenatal information that I used to drag back and forth from my midwife’s office to my home.