~CHOICES IN CHILDBIRTH~
TO CREATE A JOYOUS AND EMPOWERING BIRTH EXPERIENCE, RESEARCH AND CHOOSE YOUR MEDICAL CAREGIVER CAREFULLY.
Obstetrics has become a specialized and lucrative field for many physicians. However, many women may not realize that they don't need a specialist for their birth if they are having a normal, low-risk pregnancy and are anticipating the same for their birth.
According to the World Health Organization, midwives should be the preferred medical caregiver for low-risk pregnant women, reserving OB-GYN's for high-risk pregnancies for emergency birth complications only.
"The most appropriate person to care for pregnant women is someone with midwifery skills who lives close to the community. People trained in midwifery are qualified to provide preventive care to pregnant women, detect abnormal conditions in mothers and infants, assist women through labor and delivery and prescribe essential drugs. When delivery complications arise, those providing midwifery care especially at the community level need to be able to carry out emergency measures if medical help is absent, and get medical assistance or refer women to an appropriate health facility."
WHO/FIGO/International Confederation of Midwives, "Definition of the Midwife", 1992
The California Association of Midwives once detailed a lovely and comprehensive description of the Midwifery Model of Care: "In the midwifery model of care, the woman maintains power and authority over herself. Responsibility is in the hands of the woman, shared with her partner and midwife. The goal is to assist the woman toward self-care as a healthy person in a state of normalcy. The mother and baby are a unit whose medical and emotional needs are complimentary; what meets the needs of one meets the needs of both. The woman's body is a well-functioning home for herself and her baby. Its needs and workings are best known by the woman herself. The emphasis is on pregnancy and birth as times of physical, psychological and emotional growth for the mother and fetus. Childbirth is seen as an activity that the healthy woman engages in. The midwife guides and educates the woman during her experience. Childbirth is seen as an event in the lives of the woman and her family. The woman's active birth-giving is enhanced by education, support, and skilled care." (reprinted with permission)
The Midwives Model of Care definition was created by midwives and consumers as a tool for advocating midwifery. The definition was created jointly by the Midwives Alliance of North America (MANA), the North American Registry of Midwives (NARM), the Midwifery Education Accreditation Council (MEAC) and Citizens for Midwifery (CfM) in 1996, and is copyrighted by the Midwifery Task Force.
Citizens for Midwifery (CfM), is a non- profit, volunteer, grassroots organization. Founded by several mothers in 1996, it is the only national consumer-based group promoting the Midwives Model of Care.
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The Midwives Model of Care is based on the fact that pregnancy and birth are normal life processes.
The application of this woman-centered model of care has been proven to reduce the incidence of birth injury, trauma, and cesarean section. *Copyright (c) 1996-2001, Midwifery Task Force, Inc. Reprinted with permission. All Rights Reserved. |
Interview your potential medical caregiver carefully before choosing them for your pregnancy and birth. Ask pointed questions regarding their cesarean rate, how they handle various aspects of pregnancy, labor and birth, and their personal as well as professional philosophy regarding labor and birth.
Women that don't ask pointed questions before choosing their caregiver may receive a different type of care than they anticipated. Invariably, these women find themselves asking these types questions when they are much further along in their pregnancy and may not be happy with the answers they receive. While you always have the option of changing medical caregivers if you become unhappy with the care you are receiving, many women are intimidated having to do so when they are towards the end of their pregnancy.
Since most women are reluctant to change medical caregivers late in pregnancy, try not to put yourself in this situation. Make certain you do your homework before you pick your medical caregiver, and find someone that you feel will be compatible with your ideas for your labor and birth experience. Ask for and check out references from previous clients.
Read my SAMPLE LIST OF QUESTIONS YOU MAY ASK YOUR MEDICAL CAREGIVER handout.
CITIZENS FOR MIDWIFERY (CFM) has developed an excellent brochure about the Midwives Model of Care©. A PDF version of the brochure is available online. For a free print sample, or to order brochures, please download the order form. For additional information about Citizens for Midwifery, please visit their website at www.cfmidwifery.org.
Read the COALITION FOR IMPROVING MATERNITY SERVICES (CIMS)--"HAVING A BABY? TEN QUESTIONS TO ASK" .
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Technocratic Model of Birth & Holistic Model of Birth Compared by Robbie E. Davis-Floyd (as summarized in her book "Birth as an American Rite of Passage") |
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TECHNOCRATIC MODEL |
HOLISTIC MODEL |
| male perspective | female perspective |
| male-centered | female-centered |
| women = objects | women = subjects |
| male body = norm | female body = norm |
| female = defective male | female normal in own terms |
| female reproductive processes abnormal | female reproductive processes normal |
| body = machine | body = organism |
| pregnancy and birth inherently dysfunctional | pregnancy and birth inherently healthy |
| mind is above, separate from body | mind and body are one |
| classifying, separating approach | holistic, integrating approach |
| doctor = technician | midwife = nurturer |
| hospital = factory | home = nurturing environment |
| baby = product | mother/baby inseparable unit |
| fetus grows itself through mechanical process | intimate connection between growth of baby and state of mother |
| fetus is separate from mother | baby and mother are one |
| safety of fetus pitted against emotional needs | safety of baby and emotional needs of mother are the same |
| best interests of mother antagonistic | good for mother = good for child |
| supremacy of technology | sufficiency of nature |
| importance of science, things | importance of people |
| institution = significant social unit | family = essential social unit |
| action based on facts, measurements | action based on body knowledge and intuition |
| only technical knowledge is valued | experiential and emotional knowledge valued as highly as or more than technical knowledge |
| appropriate prenatal care is objective, scientific | best prenatal care stresses objective empathy |
| health of baby during pregnancy through drugs, tests, techniques | health of baby insured through physical and emotional health of mother, attunement to baby |
| pain is unacceptable | pain is acceptable |
| analgesia and anesthesia for pain during labor | mind/body integration, labor support for pain |
| labor = a mechanical process | labor = a flow of experience |
| time is important; adherence to time charts during labor is essential for safety | time is irrelevant; the flow of a woman's experience is important |
| birth must happen within 26 hours | labors can be short or can take several days |
| once labor begins, it should progress steadily; some intervention necessary in all births | labor can stop and start, follow its own rhythms of speeding up and slowing down; facilitation (proper food, effective positioning, support) is appropriate, intervention usually not |
| environment is not relevant | environment is key to safe birth |
| uterus = an involuntary muscle | uterus = responsive part of whole |
| woman in bed hooked up to machines with frequent movement | woman doing what she feels like - sexual |
| frequent exams by staff is appropriate | eating, sleeping--is appropriate |
| once a Cesarean, always a Cesarean for many women | vaginal birth after Cesarean normal |
| VBAC high risk | VBAC low risk, normal |
| Cesarean for breech | hands and knees for breech |
| birth = a service medicine owns and supplies | birth = the hard work of women |
| obstetrician = supervisor/manager/skilled technician | midwife = skillful guide |
| the doctor controls | the midwife supports, assists |
| responsibility is the doctor's | responsibility is the mother's |
| the doctor delivers the baby | the mother gives birth to the baby |
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