The Midwife Model of Care
As soon as we found out we were expecting, I did what many pregnant American women do: I started watching “A Baby Story” religiously. The dozen or so episodes I watched left me with a relatively unpleasant impression of labor and delivery.
Doctors, speaking with an impatient and detached authority, often paint their laboring patients as helpless and at the mercy of their own bodies. Women who are completely capable of delivering babies safely and naturally are forced into situations in which they feel as if their choices have been taken from them. The medicalization of birth has enabled doctors to place mothers into false dilemmas that lead to a snowball of unnecessary interventions. These interventions (induction, monitors, mandated delivery positions, c-sections, etc.) can be more harmful to both mother and newborn than the scare tactic alternatives waved around by doctors.
Searching for something different, I borrowed a copy of “Baby Catcher: Chronicles of a Modern Midwife,” and it completely changed my mindset about modern obstetrics. Baby Catcher exposed me to a completely different theory of pregnancy and birth. Birth should not be viewed as a series of emergencies; it is not a disease that needs to be monitored for signs of danger. The midwife model of care treats pregnancy and birth as normal, healthy processes. Midwives work with parents to empower mothers and make birth the joyous experience it should be.
The majority of pregnancies are normal, and all women should be able to enjoy their birthing experience regardless of who is present at the birth (doctor, midwife, and/or birth team) and where the woman chooses to have the baby (at a hospital, a birth center, or at home).
Two of the major decisions women make when pregnant are 1) where to give birth and 2) who will attend the birth. Even though research has shown that births in hospitals, birthing centers, and at home are equally safe, a hospital birth is a given to most women.1 In fact 99% of women give birth in hospitals.2 We chose to have Kieran in a birth center with a midwife. I decided that I wanted to work with a midwife because we wanted a natural birth and more personal attention. When we have a second baby, we will opt for a home birth.
Only about 8% of births in the United States are attended by a midwife.3 This number is drastically lower than the rest of the world, where more than 70% of births are attended by midwives.4 If more women were exposed to the midwife model of care, I am certain that our numbers of midwife-attended births would climb rapidly.
The Midwife Model of Care
The midwife model of care is a much different approach to pregnancy and birth than the medical model. Midwives are committed to you: they spend more time with you during your prenatal appointments, they support your informed decisions about your care and birth plan, they strive to build your confidence, they are nurturing and empowering, and they reduce unnecessary interventions while helping you cope naturally during labor and birth.5
Midwife-assisted births result in fewer interventions including induction, rupture of membranes, episiotomies and cesareans; they also have lower rates of newborn and mother deaths. “These results reflect a fundamental difference in perspectives. Physicians are trained to look at pregnancy in terms of what might go wrong, and to intervene at the first sign of trouble. Midwives ‘approach birth as a normal, natural, healthy life event . . . .’”6
In a recent study, researchers compared three groups of women, those with: 1) planned home births attended by a midwife; 2) planned hospital births attended by a midwife; and 3) planned hospital births attended by a physician. All women in the three groups were eligible for a home birth (in other words, they were all “low risk”). Among the three groups, the babies born at home had the lowest rate of perinatal death. Women who were assisted by a midwife (both at home and in the hospital) were significantly less likely than women assisted by a physician to have obstetric interventions (fetal monitoring, assisted vaginal delivery) or adverse maternal outcomes (perineal tears, postpartum hemorrhage). Babies born at home were less likely to need resuscitation at birth or oxygen therapy after 24 hours, they were also less likely to have meconium aspiration.7
Several studies have demonstrated that women who birth with midwives are less likely to need medical interventions such as episiotomies and cesarean sections.8 While “obstetricians. . . . perform cesarean sections on 19% or more” of healthy low-risk women, only 3 to 4% of women with midwife-assisted births need a cesarean section.9
In addition to the physical benefits of having a midwife-assisted birth, there are also monetary benefits. “Americans could save $13 billion to $20 billion annually in health care costs by developing a network of midwifery care providers, demedicalizing childbirth, and encouraging breastfeeding.”10
From a personal standpoint, I can attest to the patience and decreased intervention of a midwife. Kieran was posterior, and I found out later that my 30ish hours of back labor would have easily translated to a c-section at any hospital. Fortunately, my midwife allowed me to labor in my own time – first in bed, then in the tub, then with a half dose of Stadol (to help me sleep; it didn’t work), then with nipple stimulation and a plethora of different labor/pushing positions, and finally on the birthing stool where Kieran was finally born looking up into my eyes.
My midwife made me feel like a mother before I held my baby in my arms. She helped Tom and I take ownership of pregnancy and birth, and she left us alone to labor together. I remember rocking freely back and forth in Tom’s arms in the long, frozen hours of the night before Kieran’s birth. At a hospital, I would have likely been hooked up to an IV and monitors, tethered near a barred bed. At the birth center I wandered wherever my contractions led me, and I received no internal exams until I wanted one – not in any of my prenatal visits, not until I had been laboring for approximately eight hours.
If you have never thought about anything except an OB and a hospital birth, you may want to reconsider. Try reading Baby Catcher; see if the stories Peggy relates move your heart. You have alternatives, and it is not too late to switch from an OB to a midwife (we did not meet our midwife until I was six months pregnant).
The American College of Nurse-Midwives and Citizens for Midwifery contain resources to help you find a midwife in your area. gentlebirth.org contains some thoughtful questions you can ask midwives or obstetricians when you are interviewing potential birth assistants.
Statements on this website have not been evaluated by the Food and Drug Administration. Products and/or information are not intended to diagnose, cure, treat, or prevent any disease. Readers are advised to do their own research and make decisions in partnership with their healthcare provider. If you are pregnant, are nursing, have a medical condition, or are taking any medication, please consult your physician. Nothing you read here should be relied upon to determine dietary changes, a medical diagnosis, or courses of treatment.
- Choosing Your Birth Practitioner ↩
- The sources I found revealed that 99% of women give birth in hospitals while only 1% of women give birth at home. Surprisingly, I was unable to find a number for babies born in birth centers, so I am unsure if they are lumped into the 99% statistic. See Doctors v. Midwives: The Birth Wars Rage On, Jeffrey Kluger; Most U.S. Babies Born in Hospital, Study Says ↩
- Choosing Your Birth Practitioner ↩
- Introduction to Midwifery; see also Choosing Your Birth Practitioner ↩
- Midwives Model of Care Brochure ↩
- Up Close and Personal: Midwives Offer Personalized Care ↩
- Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician, Patricia A. Jannsen, Ph.D., et al. ↩
- Cesarean section rates in low-risk private patients managed by certified nurse-midwives and obstetricians, Lorna G. Davis, et al.; Out of Hospital Midwifery Care; Access to Certified Nurse-Midwives Reduces Cesarean Section Rates Among Massachusetts Hospitals, Kelly Roberts and Allison Vitonis; Facts About Midwives, Midwifery, and Homebirth ↩
- Out of Hospital Midwifery Care ↩
- Midwifery Facts ↩
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