the midwives model of care

one of the biggest questions i get when i talk about my homebirth is about midwives. what is a midwife? what are her qualifications? what was it like to see a midwife verses an OB/Gyn?

direct quote from my dad when my mom was telling him that i was having a home birth with a midwife: "so what qualifications does a midwife have anyway??" lots! lol.

first, let's look at the midwives model of care, taken from citizens for midwifery:

The Midwives Model of Care is based on the fact that pregnancy and birth are normal life processes.
The Midwives Model of Care includes:
  • Monitoring the physical, psychological, and social well-being of the mother throughout the childbearing cycle
  • Providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support
  • Minimizing technological interventions
  • Identifying and referring women who require obstetrical attention
The application of this woman-centered model of care has been proven to reduce the incidence of birth injury, trauma, and cesarean section.
to read more in depth about the midwifery model of care, you can click on this link to get to a .pdf brochure - it is very good and i encourage reading it to gain a better understanding of what type of treatment you'll receive from a midwife.

with midwives you can expect respectful treatment, personal attention, plenty of information, appropriate monitoring, confidence in your body, natural techniques for comfort, and a caregiver who stays with you.

here is another great article about the midwives model of care. this article is good and talks very in depth about the difference between the models of care of midwives and doctors.

midwives first priority is safety. surprisingly, many women (including myself just a few months ago) do not realize that for a low-risk pregnancy, a midwife might be the best choice. research has consistently noted equal or better outcomes for midwife versus physician assisted low-risk births, citing significantly lower rates of interventions such as induction of labor, artificial rupture of membranes, episiotomies, and cesareans. these results reflect a fundamental difference in perspectives. midwives are committed to nonintervention thus they do not advocate the use of pain medication or invasive procedures during the normal birthing process. they also encourage women to actively participate in the birth process. having a midwife continuously present during labor can reduce the length of labor, the need for pain medication, the likelihood of forceps or other operative devices during delivery, and the possibility of a cesarean delivery.

there are two different types of midwives - direct entry midwives (CPM or LM) and certified nurse midwives. the difference between the two is that one has previous background in nursing while the other goes straight into midwifery education. the education takes about three years to complete although certification and licensing requirements vary by state. most CPM's and LM's do primarily home births or birth center births, while CNM's do hospital births and birth center births.

having seen both an OB/Gyn and a midwife, i have experienced both sides of the "coin." i have seen two OB/Gyn's - one was a very traditional doctor, the other was much more forward thinking and supportive of birth as a natural process. my appointments with each of them were very similar - normal wait (sometimes rather long at my first OB) in the waiting room, a nurse brings you back, takes your blood pressure and your urine sample, you wait in the waiting room, then spend maybe 5 if you're lucky 10 minutes with the doctor. they ask if you have any questions and you rack your brain and finally answer...i don't think so. or if you do have a question, you ask it and get a fairly short response. then, you go on your way. (note that these are my experiences, yours may have been similar or different).

with my midwife, i had an hour long appointment where we would do the normal things like check my blood pressure, my urine (she had me dip the stick myself and i was actually able to see what all the levels were...very neat and educational!), check the fundal height, listen to the baby's heartbeat, etc. the major difference was the level on which i came to know my midwife. i felt very comfortable asking any questions and always got in depth responses. we also chatted about every day things and truly formed a friendship. i felt much more comfortable with her than i did with either one of my doctors (one of my OB's was a man, the other was a woman, so i've had experience with both genders). she called me a "client" rather than a "patient." she texted me or called me to check on me as the birth of my baby approached - it was a very close relationship, one that i imagine does not happen very often with a doctor (simply because of how many patients a doctor has and the model of care differs quite a bit).

the experience, for me, with a midwive, was overall so much different. she encouraged me to ask questions and learn about what things would be taking place (for example, testing for group B strep - did you know that if you get a positive result, there are things you can do which will help normalize the levels of group B strep in your body, thus making it so if you test again, it could be negative thereby making it unnecessary to receive antibiotics?). she encouraged me to make my own decisions based upon what i researched rather than just doing things (like tests, etc.) blindly, if that makes sense.

if you are pregnant or plan to become pregnant at some time in the future, it would be a good idea to research the differences between doctors and midwives and then choose one based on which you feel would be a good fit for you personally. while a doctor may be a great fit for one woman, a midwife may be a great fit for another, and vice versa. having a care provider that has the same ideas about labor and childbirth as you is essential.

stay tuned for a post about interviewing care providers...something most people don't do, but should!