Midwifery vs. Medical models of care

As a doula, one of the very first questions I ask my clients is what is their belief system around birth? What are their birth experiences? What do they know about their own birth? I want to understand their perception of birth in their birth culture.

What the majority of families describe is a hands-off, family-centered, low intervention, natural feeling of care. They talk about wanting to be seen as a normal person who’s having a baby and not a medical condition. ​

When I’ve asked childbearing women to describe the midwifery model of care, I hear words such as:

• Mom-focused
• Low stress
• Patient
• Trusting
• Nurturing
• Personal
• Comfortable

The Midwives Model of Care™ is based on the fact that pregnancy and birth are normal life events. 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 and
• identifying and referring women who require obstetrical attention

(Midwives Model of Care definition is Copyrighted © by the Midwifery Task Force, all rights reserved)

This model of care is not only restricted to a hospital setting. There are midwives in the U.S. and all over the world who are specifically trained to attend homebirths.

In Alabama, Certified Nurse Midwives (CNMs) practice in a shared practice with a collaborating OB. In 2017, Alabama state legislation recognizing Certified Practicing Midwives (CPMs) to attend homebirths was passed. A state midwifery board has been established and is working towards issuing licensure.

In April 2016 Cochrane, a non-profit medical research group, published a meta analysis of 15 studies with 17,674 mothers and babies, concluding: “...women who received midwife-led continuity models of care were less likely to experience intervention and more likely to be satisfied with their care with at least comparable adverse outcomes for women or their infants than women who received other models of care.”

Look up the midwives in your community if you are seeking a hands-off, low-intervention model of care for your pregnancy and birth.

There are those whose belief systems line up better with the medical model of care. When I ask birthing families words to describe the medical model of care, I hear words such as:

• handling complications
• rushed
• treat like an illness
• emergency
• highly-managed

There will always be those who feel more comfortable with this model of care, especially if there is a risk factor during the pregnancy.

Obstetrics is defined as "the branch of medical science concerned with childbirth." Obstetricians are trained in emergency and a high risk management of pregnancy and birth. If you are low risk, you may not fit this model of care. OBs are more likely to think more medically about pregnancy and birth because of their specialty training in emergency medicine.

In Alabama, CNMs collaborate with OBs in a shared practice to take care of the patients. This is a great “middle option” for those who want a non-medicalized relationship with a midwife and the medical “backup” of an OB. If there is any indication of an issue when seeing a CNM, there is always the opinion of the OB.   

As the CPM board approaches full operation, Alabama is preparing for education and collaboration with midwives. If homebirth is your hope, this option is coming soon.

Birth is normal, until it’s not.  There are no wrong answers when you are trying to find the right care provider for your belief system. I hope you find the perfect fit for you.

Here are the CNMs practicing in the state of Alabama (current as of September 2018). 
​
Montgomery (Hospital affiliation: Baptist Medical Center East)

• Vicki Brooks, CNM
• Charla Smith, CNM
• Dana Moore,CNM
• All in the practice of OB/GYN and Associates 

Birmingham (Hospital affiliation: Princeton Medical Center)

• Simon-Willamson Clinic Obgyn and Midwifery
• Collaborative OBs: Dr. Jesanna Cooper and Dr. Antonia Williams  
• Hamilton Yarbrough, CNM
• Sheila Lopez, CNM
• Stefanie Fieno CNM provides clinic care, but does not attend births

Enterprise: (Hospital Affiliation: Medical Center Enterprise)

• Megan Leigh Dickey, APRN-CNM
• MCE Medical Group OBGyn

Florence:

• Balance Birthing Center (in progress of being established at the time of writing)