Pregnancy & Birth

Models of Maternity Care

The care you receive during your pregnancy, labor, and childbirth will vary according to the type of provider and birth setting you choose. The different training that midwives and doctors receive prepares them to approach pregnancy and childbirth differently. In the United States, there are two main paradigms in maternity care training, described as the midwifery model and the medical model.*

The classic midwifery model is based on the assumption that most pregnancies, labors, and births are normal biological processes that result in healthy outcomes for both mothers and babies. It focuses on maximizing the health and wellness of a woman and her baby, identifying and managing medical problems early on, and attending to the emotional, social, and spiritual aspects of pregnancy and birth. Midwifery care seeks to protect, support, and avoid interfering with the unique rhythm, character, and timing of each woman’s labor. Midwives are trained to be vigilant in identifying women with serious complications. Medical expertise and interventions are sought when necessary, but are not used routinely. In most parts of the world, midwives are the primary caregivers for women with uncomplicated pregnancies. (For more information, see “The Midwifery 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. 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 and even lifesaving at times. However, interventions can also interfere with the normal rhythms of birth and actually create problems. Training in the medical model does not typically focus on developing skills to support the natural progression of an uncomplicated birth. In addition, under the medical model, care generally follows a certain routine. This standardization reduces individualized care, but it can protect women from poor medical care and increase safety and healthy outcomes overall. Providers who work in medical settings (including nurse-midwives) are often constrained by hospital protocols (such as policies forbidding vaginal births after cesarean sections), insurance requirements, and liability concerns. The medical model of birth is prevalent in the United States today.

The midwifery model of care and the medical model of care are linked to certain birth outcomes. Healthy women (with healthy infants) working with midwives generally have fewer interventions than those working with physicians, and comparable (sometimes even better) outcomes.² This is also true for women in challenging social circumstances (for example, low- income or teenage mothers). Women who are experiencing complicated pregnancies can also benefit greatly from many traditional midwifery approaches while also working with a medical specialist.

Although it is crucial to understand the differing philosophies and training among practitioners, it is also important to note that the letters after someone’s name do not tell you much about her or him as an individual. Some doctors have attitudes, styles, and approaches that fit the midwifery model, and some midwives incorporate the medical model that is more common for doctors.

The vast majority of us enter pregnancy as healthy women, with no major medical problems. If this is true for you, you can choose from the full range of providers and birth settings available in your area. If you have a serious medical condition or are at risk for developing such a condition, an obstetrician or maternal-fetal medicine specialist should be on your team.

NOTES

* These terms derive from the kinds of care physicians and midwives have historically provided. However, their use is not meant to imply that all midwives follow a midwifery model or that all physicians follow a medical model. Some people believe it is more accurate to refer to the different models of care as a physiologic model (that is, care in accord with the normal functioning of a woman’s body) versus an interventionist or pathology- driven model. [back to text]

2. Childbirth Connection, “Choosing a Caregiver: Best Evidence: Caregiver,” accessed at www.childbirthconnection.org/article.asp?ck=10155 on July 18, 2006. [back to text]

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Excerpted from Chapter 2: Choosing Your Health Care Provider and Birth Setting in Our Bodies, Ourselves: Pregnancy and Birth  © 2008 Boston Women's Health Book Collective

Excerpted from Our Bodies, Ourselves: A New Edition for a New Era, Copyright © 2005, Boston Women's Health Book Collective.