Choosing a Provider: The Midwifery vs. Medical Models of Care
Choosing a provider: Midwifery vs. Medical
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.
The 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.
According to The Citizens for Midwifery the application of the woman-centered model of care has demonstrated efficacy in reducing the incidence of birth injuries, trauma, and cesarean sections.
“The application of this woman-centered model of care has been proven to reduce the incidence
of birth injury, trauma, and cesarean section.”
RELATED: Using a Midwife: Types of Midwives
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 USA, typically adhere to the medical model of care, which emphasizes the management of potential complications and the utilization of medical interventions as deemed necessary.
Midwifery vs. Medical Models of Care:
Midwifery Definition of Care vs. Medical Definition of Care
- Holistic, woman-centered care.
- Values informed decision-making.
- Minimal intervention, promotes natural birth.
- Emphasizes trust and mutual respect.
- Medical management and intervention.
- Often paternalistic decision-making.
- Relies on technology, protocols.
- Hierarchical structure of care.
Midwifery Birth Environment vs. Medical Birth Environment:
- Promotes relaxation, intimacy.
- Supports freedom of movement.
- Home-like settings, comforting atmosphere.
- Encourages support from birth team.
- Focuses on clinical efficiency, safety.
- May limit mobility, strict protocols.
- Availability of emergency resources.
- Standardized hospital protocols.
Midwifery Philosophy and Practices vs. Medical Philosophy and Practices:
- Values natural birth, minimizes interventions.
- Prioritizes continuity of care.
- Integrates evidence-based and traditional practices.
- Empowers informed decision-making.
- Manages risk, higher intervention rates.
- Fragmented care, less continuity.
- Adheres to clinical guidelines.
- Relies on medical expertise, technology.
Which provider is right for YOU?
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 a 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
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