Birth and the Two Models of Care

Whether you choose an OB or a midwife to provide your pregnancy, birth and postpartum care, there is something that will influence the outcome of your experience more than anything. This is whether your provider practices under the medical model of care or the midwifery model of care.

It seems like it would be pretty cut and dry - OB's practice the medical and Midwives practice the midwifery. Right?

While the vast majority of the time this might be true, there are still plenty of exceptions.

The two models of care by definition:

The Midwives Model of Care

The Midwives Model of Care is based on the fact that pregnancy and birth are normal life processes.

The Midwives Model of Care includes:

• Monitoring the physical, psychological, and social well-being of the mother throughout the childbearing cycle
• Providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support
• Minimizing technological interventions
• Identifying and referring women who require obstetrical attention

The application of this woman-centered model of care has been proven to reduce the incidence of birth injury, trauma, and cesarean section.

Copyright (c) 1996-2008, Midwifery Task Force, Inc., All Rights Reserved.

http://cfmidwifery.org/mmoc/define.aspx

I couldn't find a definition of the medical model of care, but I found this table making some comparisons of the two models:

Midwives Model of Care Medical Model of Care Definition: Definition: • Birth is a social event, a normal part of a woman's life. • Birth is the work of the woman and her family. • The woman is a person experiencing a life-transforming event. • Childbirth is a potentially pathological process. • Birth is the work of doctors, nurses, midwives and other experts. • The woman is a patient. Definition: Definition: • Home or other familiar surroundings. • Informal system of care. • Hospital, unfamiliar territory to the woman • Bueaucratic, hierarchical system of care Definition: Definition: • See birth as a holistic process • Shared decision-making between caregivers and birthing woman • No class distinction between birthing women and caregivers • Equal relationship • Information shared with an attitude of personal caring. • Longer, more in-depth prenatal visits • Often strong emotional support • Familiar language and imagery used • Awareness of spiritual significance of birth • Believes in integrity of birth, uses technology if appropriate and proven • Trained to focus on the medical aspects of birth • "Professional" care that is authoritarian • Often a class distinction between obstetrician and patients • Dominant-subordinate relationship • Information about health, disease and degree of risk not shared with the patient adequately. • Brief, depersonalized care • Little emotional support • Use of medical language • Spiritual aspects of birth are ignored or treated as embarrassing • Values technology, often without proof that it improves birth outcome

http://www.morningstarbirth.com/index.cfm?event=pageview&contentPieceID=3225

M(idwives in) D(isguise)

Some OB's, even while working in the hospital, do work under the assumptions of the midwifery model of care. One indicator would be their percentages of interventions (induction, c-section, vacuum, forceps, episiotomies, etc). Low percentages of interventions would indicate they may work under the midwifery philosophy, using interventions only when REALLY necessary.

MEDwives

In contrast, some midwives who work in hospitals work under the medical model of care. They usually work closely with an OB. Their purpose is more as an attraction to women who want a midwife but still opt for a hospital birth. The care is similar to that of an OB.

The "title" your caregiver possesses does not necessarily dictate the kind of care you will get or the kind of birth you will have. It is important to find a caregiver whose birth philosophy matches your own if at all possible. Yes, we all want healthy babies in the end. But our experiences in childbirth, our hopes and desires, matter as well.

-S