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Midwife

Choosing a provider: Understanding the medical and midwifery models of care

What is the difference between the midwifery and the medical model of care?

One of the first decisions that a woman makes, after her discovery of pregnancy, is her choice of care provider. In most countries, there are two basic care providers available- the obstetrician and the midwife. There are many factors that contribute to which provider will work best for your birth. A basic understanding of the common differences in their approach can help you make the best decision for your family.

Midwifery model of care-

Most midwives, whether working out of a hospital or attending home births, practice what is known as the “midwifery model of care.” The basic midwifery approach to birth and the pregnant woman tends to be more holistic. This means that they look at all factors which may contribute to the health and safety of the woman and her birth. Emotions, living situations, nutrition, and education should all be addressed by someone providing the midwifery model of care.

At the time of birth, this care provider will be aware of and trained to spot things that may go wrong, but will, overall, consider childbirth a natural process that frequently proceeds normally and safely.

Those trained in the midwifery model of care routinely refer out to an obstetrician when they observe that the pregnant woman needs to be cared for by someone with a deeper knowledge of pathology.

The Citizens for Midwifery note that,

“The application of this woman-centered model of care has been proven to reduce the incidence

of birth injury, trauma, and cesarean section.”

Medical model of care-

A practitioner using the medical model of care, as is common among western medical doctors, tends to approach the patient from a problem solving approach, searching for the defect or dysfunction and trying to fix it. Unlike the midwifery model of care that seeks to understand the whole person and prevent unnecessary intervention or surgery, things are viewed from a pathological model searching for the problem and a solution.

Obstetricians, who provide the bulk of medical care for birthing women in the United States of

America, frequently approach their patients and their pregnancy and birth from this angle.

Which is right for me?

When choosing your care provider, there are many factors to consider. One would be your own philosophy towards birth. Do you view birth as a normal life event or as a pathology or disease?

Assessing your own beliefs will help you choose a care provider that best matches your own needs.

Another thing to consider is your own health and wellbeing. If you or your pregnancy are high risk, for some reason, then choosing an obstetrician who approaches birth from the medical model of care and who is versed in your risk factors in particular may be the choice that works best for you and your family.

It is also important to realize that not all midwives use the midwifery model of care and not all obstetricians use the medical model of care. You may be able to find an OB who views birth as a normal, healthy life event and approaches it with minimal interventions. You will also find midwives who have come to view birth as dangerous and pathologic and who have high intervention and cesarean section rates in their practices. Interviewing your individual care provider and asking for experiences from other mothers, doulas, and your childbirth educator will help give you some idea of their practice and philosophy.

Take your time and research your care provider. Your birth and your baby are worth the effort!

References:

Citizens for Midwifery- “Midwives Model of Care” brochure

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

CIMS- Coalition for Improving Maternity Services

http://www.motherfriendly.org/MFCI/

How Birth Boot Camp Supports Midwives


 

One thing that is very important to us at Birth Boot Camp is supporting and encouraging the midwifery model of care. We are honored to have a very experienced and insightful midwife, Melody Morrow, CPM, as a member of our Advisory Board. Why is Melody so excited about Birth Boot Camp? She has seen the classes improve outcomes for her clients. Here are a few of her words. Thank you, Melody, for your support!

*****

Birth Boot Camp childbirth education has had an incredible impact on my midwifery practice.  As a midwife, I have found that the midwifery clientele has shifted recently and become more mainstream. Women are now choosing midwifery care that haven’t necessarily researched and taken responsibility for their choices in birth. Some just want to try a waterbirth because it looked cool on television. What this means for me as a midwife is that if I take these clients, I have to make sure they are properly educated before the birth.  If they don’t receive that education, I will likely be spending many, many more hours with them in pre-labor, labor and possibly a traumatic transport to the hospital.

I began to require that all my primips (first time moms) and women birthing outside the hospital for the first time take a childbirth class. While something was better than nothing, I didn’t necessarily notice a significant difference in outcomes for my clients who took a short class (4-6 weeks). However, I did notice that clients who took a longer Birth Boot Camp class did often have very different outcomes. Women were less fearful and more determined. They participated in their care and were making informed choices. Dads were providing excellent, confident support throughout pregnancy and, noticeably, in labor. Moms who would have otherwise had epidurals or C-sections, were having unmedicated births.

I believe Birth Boot Camp will enhance and support your work as a midwife because:

1. It promotes and affirms the midwifery model of care.  The Birth Boot Camp curriculum is based on the Mother Friendly Childbirth Initiative.  What they teach aligns perfectly with how I practice.

2. It gives parents 10 weeks of intentional education.  This enables parents to make appropriate decisions for their care and increases their ownership of responsibility. In short, more families “own” their birth choices.  Education lasts approximately 18-24 hours, so they simply have time to learn what they need.

3. The live classes promote peer support, encouragement and determination.  Think of these couples meeting for 10 solid weeks to learn about birth with like-minded people and a dedicated teacher who has done it before.  They are supported and positive about their birth and having more of their emotional needs met.

4. Someone else, besides you, is encouraging the same things you want them to hear.  Good nutrition, exercise, positioning, and much more are all things they are learning about OUTSIDE of your visits, not just during them.  My clients are more likely to be intentional in caring for themselves when they are given directed information, statistics, etc. and discussing these things with their partner and other birth workers.

5. Dads become more confident, involved and less fearful.  A confident and involved dad really helps with mom’s well-being.  Many clients will become even more passionate and appreciative of the choices they are making, even if they don’t have their desired outcome.

6. It is contemporary. The films are current and interesting.  The topics concerning birth and interventions are up-to-date.  In class, they discuss babywearing, cloth diapering, chiropractic care, doulas, Spinning Babies™, and other things that we want our clients to know about, but may not have time to fully teach them.  Their class will connect them to resources that I might not be able to.

7. It forces couples to stop and focus on their pregnancy in this fast paced world.  Couples connect with their pregnancy and with each other. They discuss issues and they come to an understanding. They appreciate their baby and the experience together.  I wish every couple did this!

 8. Knowledge is power. This means less confused, fearful phone calls and false labor runs for you.

In short, when my couples access the kind of quality childbirth education provided by Birth Boot Camp they have a better birth experience, my job is easier, and if things don’t go as they planned, they are comforted in knowing that they did all they could.  This kind of childbirth education truly makes a difference.

Melody Morrow, CPM, LM, BBCI loves babies and birth. Since 1998 she has attended over 1,100 births and assisted in the training of over 70 midwifery students. She is passionate about preventative, respectful care for mothers, babies, and their families. Melody works in Texas at Edenway Birth Center as the administrator and senior consulting midwife. She is enthusiastic about her calling and loves to help empower families as they become informed and educated about their choices during their maternity and birth experiences.

4 Simple Ways to Prepare for Natural Birth

Congratulations on your pregnancy!  Many women desire a natural birth but preparing for one can seem overwhelming.  Here are some wonderful tips for preparing yourself for the best natural birth possible.  There is so much you can do to ready yourself and your family for birth.  With these four simple things: education, nutrition, birth place, and birth team, you will be more able to make your goal a reality.  

#1-Education-  Probably the most important step in preparing for natural birth is to educate yourself as much as possible.  Just as with breastfeeding, the more you know about the benefits of natural birth for you and your baby, the more motivated you will be to follow through and prepare accordingly.

Of course there is a plethora of information out there on birth.  How do you trudge through it and find the diamonds among the coal?  First, a comprehensive childbirth education program is a must.  Look for one that is longer rather than shorter.  A weekend “crash course” cannot possibly give you all the information that you need to navigate policies, stay low risk and prepare properly for the birth you want. 

Look for natural childbirth classes that cover staying low risk, nutrition and exercise, relaxation techniques, choosing a care provider and birth place, the stages of labor, preparing your partner, common policies and procedures, breastfeeding and newborn care, and possible complications and how to avoid them. 

Not only will a good birth class help prepare you, it should prepare your partner as well.  In all honesty, your partner’s preparation is tantamount.  If they are frightened or simply unaware of normality, it will inevitably impact the birth negatively. 

In addition to preparing your partner, your natural birth instructor will be able to guide you to find the best books, websites, even care providers and doulas in your area.  Think of a childbirth instructor as somebody on the “inside.”  They have been there and done that and now they can help you accomplish the same thing.  (Our instructors are well trained women who have had natural births, themselves.  You can see a list of their requirements here.)

#2-Nutrition-  As you will quickly learn, preparing your body for a natural birth is just as important as preparing your mind.  Your body will go through some drastic changes as it grows first a placenta, then a baby, adds fluid, almost doubles its blood volume and prepares for future breastfeeding. 

Eating properly means not just avoiding refined foods such as sugars, white flours, packaged foods and chemical sweeteners, it also means adding the right foods into your diet.  Daily nutrition should include several servings of greens (broccoli, spinach, kale, asparagus, etc), citrus foods (oranges, tomatoes, kiwis, bell peppers), vegetables and fruits (celery, cucumbers, bananas and apples), whole grains (spelt, quinoa, oatmeal), eggs, complete protein sources (meats or other combined proteins such as beans and rice) and dairy (milk, Greek yogurt, keifer). 

Women are amazed at how much better they feel when eating properly during pregnancy. Many common pregnancy ailments disappear. Great nutrition and adequate protein can even help eliminate morning sickness.  Your childbirth instructor can provide you with a complete system to chart your nutritional intake and make corrections, if needed.  You can also find many phone apps with which you can keep track of your daily nutrition throughout pregnancy. 

Great nutrition will help your body and your baby be ready for a natural birth.  Many care providers believe that common ailments that surface at the end of pregnancy and often lead to induction or C-section can actually be avoided with optimal nutrition.

#3-Choose Your Birth Place Carefully-   One of the most important choices, as you prepare for a natural birth, is your choice of birth place.  Many factors play into this decision from insurance coverage to proximity.  Women often have three main choices available to them when it comes to birth place:  hospital, birth center or home.  The birth place that works best for you and your family will be influenced by many things, from cost to your own health to where you feel most emotionally comfortable. 

Wherever you choose to birth, be sure that the policies are not so prohibitive that they make natural birth nearly impossible.  Some important policies to look for are:

  • Women are encouraged to eat and drink in early labor.
  • Vaginal exams are kept to a minimum.
  • Women are encouraged to move about in labor.
  • IV’s are only given when necessary.
  • Breastfeeding is supported.
  • They have a low C-section rate. 

In a birth center, you may want a hospital nearby in case of transfer and an environment in which you feel comfortable and supported.  If choosing a home birth (as with any other birth place), you will want to carefully choose your midwife. Look specifically for someone with experience, skills or certification that you feel comfortable with. 

While it may be tempting to choose a birth place simply because it is close, doing things because they seem “easy” is an often regretted decision for birthing women.  A nearby hospital with a sky high induction and C-section rate will greatly increase your chances for the same.  In the case of an unwanted and/or unneeded cesarean section, a shorter drive for a birth place can yield a much longer recovery.  Choose your birth place carefully. 

#4-Choose Your Team Well-  You won’t win the Super Bowl with a football team made up of expert karaoke singers and you won’t get a natural birth with a team of care providers who specialize in surgical birth.  Choosing your birth team carefully is one of the best ways to ensure you get a natural birth.  Sometimes, even when a mother is knowledgeable and physically prepared, things can fall apart for her in labor if her team doesn’t support her decisions. 

So how do you find this pro-natural birth team of supporters?  Asking your childbirth instructor is a great way to start.  As a woman experienced in birth and engaged in the local birth community, she should have a list of resources to provide you with. 

There are many people who will make up your birth team. All of these people will influence your birth experience.

A great doula (a woman trained to support a birthing mother) can be a fabulous resource for both the laboring woman and her partner.  She can provide emotional and physical support, an experts view on supportive care providers, and may act as a sounding board for advice. 

Another good person to have on your team is a Webster Certified chiropractor.  Chiropractic care during pregnancy (and even birth) can help ensure the pelvis is well aligned so that it can move for a faster and more comfortable birthing experience with a better positioned baby.  This alone can help avoid many problems that prevent natural birth. 

Probably most important of all is your choice of care provider.  Your doctor or midwife will make decisions when you can’t and will be there for the final moments of birth.  It is vitally important that this person be both trustworthy and skilled.  If you are a low risk woman, you may want to consider midwifery care.  Midwives often work in hospitals (thought many can be found working in a home birth or birth center environment) and their approach to birth tends to be more supportive of  natural choices. 

You CAN Have an Amazing Birth!  Choosing a natural birth is a wonderful decision. With the right choices and preparation, we believe that most women can achieve this goal.  (Check out our stats from our students!)  Proper education, excellent nutrition, and careful choice of your birth team and your birth place are all things that can make your choice of a natural birth more attainable.  When all is said and done, sometimes things don’t go exactly as planned.  But, when we have done our best and chosen a care provider that we trust, we can rest assured that we did everything possible to accomplish our goal.

Using a Midwife (Types of Midwives)

Many women desire the benefits of midwifery care for their pregnancy but become overwhelmed when they start to look into it and find that there are many different types of midwives to choose from.

While options, certifications, and even legality vary from one state to another and from one country to the next, here are a few basic tips for deciding what type of midwife you want.  There isn’t necessarily a right answer, just different choices for different situations.

The Certified Nurse Midwife (CNM)- For women who want to be attended by a midwife in a hospital setting, the CNM is a great option.  A CNM is someone who has trained as a registered nurse and then attended further training (often a master’s program) to specialize in midwifery.  A CNM has some medical background and can function in various different settings.  Many work within a hospital, some work in or own birth centers outside of the hospital, and some even attend home births (though the legality of this varies from state to state).

The Certified Professional Midwife (CPM)- For women who desire to birth at home, a CPM is often what she will choose.  A Certified Professional Midwife is usually certified through the North American Registry of Midwives (NARM) and has completed their testing and requirements.

A CPM is not required to have the medical background that a CNM has but has completed reading, apprenticing, and testing in order to specialize in normal birth and has also studied variations and emergency situations that can occur in a birth setting.

Some states also have their own state licensing and will have licensed midwives (or LM) who have passed their state licensing.  States vary in their requirements.

There are also, in some states, Direct Entry Midwives (DEM) who have studied midwifery and apprenticed but have not necessarily licensed through an organization or school.  A DEM will work in a home or birth center setting but not within the hospital.

Knowing your options and the different types of midwives is a wonderful start to making informed birth choices for you and your baby.

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