A Silent Midwife – A reflection

by Mariska Oosthuizen-van Tonder

The phrase “The Silent Midwife” can represent the often invisible, under-recognised, but vital role of midwives in healthcare and society.

Midwives are present at the most critical moments in human life — birth, loss, and maternal recovery — yet their contributions are frequently overlooked in policy, research, and even cultural narratives.

The origin of the silence

From a historical point of view, in the first module of this course, we learned that in many cultures, midwives worked in the shadows of history. Their knowledge of birth, herbs, and women’s health was often passed orally and rarely recorded. Unique to the country's historical background during colonial and apartheid eras in South Africa, traditional midwives were silenced or discredited in favour of Western medicine, despite their vital role in rural communities.

In practice today, midwives often serve as quiet advocates, listening more than speaking, holding space for birthing women without necessarily being at the centre of attention. In labour wards, midwives’ work may seem “silent” compared to the medical interventions of doctors, yet their continuous presence and gentle reassurance are often what women remember most.

There is also a form of political/organisational silence. Midwifery is underfunded and under-recognised. According to the WHO, the world faces a shortage of nearly 900,000 midwives. In South Africa, midwives are stretched thin in overcrowded public hospitals, increasing the risks for both mother and midwife, yet their voices are often absent in policy-making compared to physicians.

Then women may experience cultural silence. Many women still experience birth trauma or lack of respectful maternity care because midwives (and women themselves) feel they cannot speak against hierarchical or patriarchal systems. The “silence” reflects not only the midwife’s lack of recognition but also the silenced birthing woman whose voice midwives often try to amplify. Midwifery, historically associated with women’s knowledge, has often been undervalued in patriarchal, dominant health systems. At the same time, the silence of birthing women — who may feel powerless in medicalised environments — mirrors the midwife’s struggle for recognition. In this sense, the midwife often acts as an advocate for women’s voices.

Reframing the silence

When reading more on the silent midwife, it made me think of the presence in relational care theory founded by Prof Andries Baart. It refers to the mindful, intentional and empathetic connection a caregiver (or in this case, midwife) has with the client. The key aspects of this theory are being fully attentive, both physically and mentally. In this, you are attuned to their needs and available to their specific needs instead of just delivering routine care (Baart & Timmerman, 2025). At the heart of impactful relational care lies the creation of a secure environment and connections where individuals are acknowledged, listened to, and comprehended, fostering profound healing and robust, supportive connections. Presence, a fundamental quality that can be taught, aids caregivers and midwives in preventing detachment and exhaustion by prioritising the human aspect of care.

“The Silent Midwife” could also carry a positive connotation:

• Silence as presence without intrusion.

• Silence as strength, resilience, and deep listening.

• Silence as the unseen hand that makes safe births possible, while mothers and babies become the focus of joy.

  
  

While silence has negative connotations of exclusion and marginalisation, it can also be reframed as a form of strength and care. Silence in midwifery can represent deep listening, non-intrusive support, and dignified presence. Recognising this duality requires a shift in how health systems, researchers, and societies conceptualise value in maternity care.

The midwife is silent, not because she has nothing to say, but because her work speaks through others. It can be the silence of holding space, where women feel safe enough to find their own voice. It can be the silence of dignity, where care is given without demand for recognition. It can be the silence of resilience, where midwives rise each day despite the strain, because they know the sacredness of their calling. Perhaps the time has come not to break her silence, but to honour it — to listen to the quiet strength of those who have always been there, guiding us through the threshold of life.

Silence in midwifery practice is not necessarily an absence of voice but a clinical ethic of presence. Unlike episodic interventions by physicians, the midwife’s role is often continuous — offering reassurance, listening, and holding space throughout labour. This presence is subtle and relational rather than authoritative, which may explain why it is undervalued in a system that prioritises technological and measurable interventions.

In conclusion, “The Silent Midwife” is both a critique and a recognition. It critiques the structural and cultural dynamics that silence midwives globally and within South Africa, while recognising the unique form of silent strength embedded in midwifery practice. To achieve maternal health equity, there is a need to un-silence midwives by amplifying their voices in research, policy, and leadership, while also respecting the intentional silences that characterise their practice of presence.

References

Baart, A.J. & Timmerman, A.B. 2025. Relational caring and presence theory in health care and social work : a care-ethical perspective. [1 online resource (xiv, 263 pages)].  Bristol: Policy Press. Available from WorldCat: https://search.ebscohost.com/login.aspx?direct=true&scope=site&db=nlebk&db=nlabk&AN=3947270.