Midwifery vs. Medical Model of Care
Please keep in mind while reading: AKRON DOULAS™ support ALL birthing desires of the families we have the opportunity to serve and in the birthing environments they choose to welcome their babies in.
Expectant couples planning their “ideal birth” often picture their two options as a choice between the home or hospital location. While this can sometimes be true in some geographical areas, it isn’t so much about here or there, but rather the model of care their selected care provider will follow. Realistically their choices are between the midwifery and the medical model of care. Depending on the care provider, they can sway one way or the other on specific topics of practice, regardless of location of birth and if they are titled a midwife or physician.
Let’s break it down!
What to Expect From The Midwifery Model of Care
A care provider that follows the midwifery model of care closely, is typically an out of hospital midwife (direct entry or nurse midwife) but can also be a nurse midwife, obstetrician or a family physician in a hospital setting (it is not so common to have a family physician attend births anymore.) They are well known for limiting the use of unnecessary technological interventions, the application of this woman-centered model of care in low risk pregnant women has been proven to reduce the incidence of birth injury, trauma, and primary cesarean section. In addition to monitoring the physical welfare of the mother, a care provider that follows this model of care also focuses on the mother’s psychological and social well being throughout her childbearing cycle. This impacts the behavior of the mother in a positive way prenatally and in the postpartum period, typically because the care provider provides individualized care and education. Her options are discussed beforehand and the mother is encouraged to educate herself through her own research in addition to the information share by her care provider. A key factor is there is a genuine sense of trust in the physiological process of birth from her care provider. Midwives (and physicians too, sometimes) that are trained in the midwifery model are familiar with the uninterrupted and unaugmented physiological process of birth. Their expertise in caring for low risk healthy mothers is also accompanied by the knowledge and ability to identify women that require obstetrical attention. Care providers who follow the midwifery model of care are far more vigilant when it comes to attending the births of the mothers they work with, shift changes are usually non existent for them, as they know this deeply effects the physiological birth experience. Depending on the practice it is common for the midwife or doctor to refer the expecting mother as a client rather than a patient since pregnancy is not a diagnosis or ailment. Their decisions regarding a mothers care are usually based solely on current evidence based information and approach any possible developing complications from a common sense stand point keeping the mothers history in mind rather than a standardized approach.
What to Expect From The Medical Model of Care
A strict medical model of care focuses on preventing, diagnosing, and treating the complications that can occur during pregnancy, labor, and birth. Therefore calling the women they care for patients rather than clients. The common denominator across the board for care providers following this model of care is that pathology does exist, even when providing care to low risk pregnant women. While we are fully aware that making use of medical expertise is essential for women who have particular conditions or illnesses, and the drugs and interventions used to manage such complications are invaluable, we cannot ignore that being intervention dependent can also interfere with the normal rhythms of birth and actually create problems for low risk mothers during childbirth. Often times the medical model of care focuses on a healthy baby and mother as a successful outcome, while disregarding the woman's physiological experience as a whole. Shift change or rotation of physicians within the institution in which women gives birth, basically gambling on which OB will actually be there at the time a mother gives birth, because even an on call physician that a family hasn’t met, has a back up in a medical setting. To add to that, usually you are accompanied by the rotation of nurses throughout the course of labor and your doctor isn't actually there until there is sign baby is coming down and out, literally. Care providers (mostly physicians) trained in the medical model do not typically focus on developing the skills to support the natural progression of an uncomplicated birth. The majority of Nurse Midwives and Obstetricians who work in medical institutions are constrained by hospital protocols (such as policies forbidding vaginal breech births, trail of labor in some instances), insurance requirements, and liability concerns even if the physician personally would like to support of the mothers decision. This has a vital impact on their ability to offer individualized care and birth choices for the pregnant women.
Which best fits your preferences & needs?
When choosing your location of birth you should always be aware of which model of care you will be subject to from your care provider, prenatally and during your labor and birth process. Evaluating which model of care best fits your personal philosophy on birth is imperative when choosing a who will be responsible for your care. The absolute most important factor is that the mother feel safe and secure in her choice, allowing her to birth with confidence. AKRON DOULAS™ support families in their informed choice of where and who they would like to birth with, there is no right or wrong answer when choosing where to have your baby.
Regardless of your birth environment (hospital, home or birth center) it is a proven that by hiring a Doula you are...
26% less likely to give birth by Cesarean 41% less likely to give birth with a vacuum extraction or forceps 28% less likely to use an analgesia or anesthesia 33% less likely to be dissatisfied with or negatively rate their birth experience.
Published data acknowledged by American Congress of Obstetricians and Gynecologists (ACOG) and Society for Maternal-Fetal Medicine (SMFM), also indicates that one of the most effective tools to improve labor and birth outcomes and the best way to avoid a primary cesarean is the continuous presence of support personnel, such as a Doula. A Cochrane meta-analysis of 23 trials and more than 15,000 women, from 16 countries, demonstrated that the presence of continuous one-on-one support during labor and birth was “more likely to give birth 'spontaneously.' i.e. Give birth with neither cesarean nor vacuum nor forceps. In addition, women were less likely to use pain medications, were more likely to be satisfied, and had slightly shorter labors. Their babies were less likely to have low five-minute Apgar scores. Given that there are no associated measurable harms, this resource is probably underutilized.”
I'll close with a quote from a dear friend who also happens to be an Obstetrician, Dr. Stuart Fischbein says “For most women, the safest place to give birth is not dependent on the address. The safest place is wherever you find a skilled practitioner.”
Blessings on your journey,
Sara Avalos AKRON DOULAS™
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