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What Does the Midwifery Model of Care look like compared to standard obstetrical care?
Here are three very common examples:
Example 1
A woman who is 20 weeks pregnant goes in for a prenatal visit. Her provider listens to the baby's heart beat.
She may be asked to wear a gown or simply lift her shirt and lie back on the exam table and her Obstetrician
listens with a Doppler and turns the volume up so that the mother and partner, if present, can hear the heartbeat.
The OB records the Beats Per Minute [BPM] and reassures the mother of the baby's health.
She sits on a chair or bed, and may be asked to lay back if it is difficult for her Midwife to find the spot where the
baby's heart is while she is upright. She will likely be given the 'ears' to the fetoscope (a stethoscope shaped
instrument used for listening to heart beat) or the Doppler and the midwife will help guide her to her baby's heart
beat. The Midwife will have told her how to count the BPM and together they will count. Many Midwives have
fetoscopes for loan for their mothers to take home with them for their pregnancies. The Midwife may choose to
listen with a Pinard Horn.
Example 2
A woman is diagnosed with Anemia (low levels of iron).
Her Obstetrician explains what Anemia is and how he plans to treat it. S/He tells her to take an Iron supplement,
recommends a brand to try that might sit well with her stomach, and orders the lab work for a follow up test at her
next appointment.
Her Midwife gives her a handout she most likely wrote herself that includes the definition of ‘anemia’, signs and
symptoms to look out for, nutritional recommendations, and resources including books, websites, and magazine
articles she should read to learn more. She will be encouraged to bring in materials she wants to share and told to
be prepared to discuss it all at her next appointment. She will also be put on an iron supplement and retested in a
month.
Example 3
A woman is in labor
In the hospital she will be:
subjected to multiple vaginal exams
*exponentially increasing her chances for infection
*asking the mother to lay down in the most uncomfortable position available to her many times
*interrupting the normal physiological process of labor
*likely removing the need to observe the mother for signs of progress in labor that would naturally occur
*creating a situation where the mother waits to hear how she is doing based on what someone's subjective finger
widths tell her, instead of feeling her labor progress and working with the natural sensations in her body as she
loses confidence in herself to know the truth
probable continuous Electronic Fetal Monitoring--though possibly at minimum for 20 minutes of each hour
*interrupting the mother's natural progress and rhythm of labor and risking that the providers will rely on the
machine for information they should get from the mother, as well as going against the methods that the inventor of
the machine held to be best (to be used as intermittent monitoring as one would normally do with a Doppler or in
high risk cases, longer).
Likely augmentation of the labor
*the use of pitocin and artificial rupture of membranes to speed labor along is often used, resulting in contractions
that come harder sooner and more frequently than the body and baby would have created if left to themselves.
This medication and procedure are often done during one of the three times labor naturally stalls before picking
up intensity to round the next corner, so to speak. This is roughly at 3 and 7 cm dilation, and again at complete
dilation before pushing starts which is the time known to Midwives as "The Rest and Be Thankful Period". The
body and baby naturally rest at these times for their own reasons yet many OB Nurses and Doctors interpret this
as a lack of function or cessation of function and introduce augmentation at these points.
She is likely to tumble into the 'cascade of interventions', outlined by the Maternity Association (click here to read)
At home or in a birth center she will be:
Only given vaginal exams upon her request, or one before she pushes if the midwife wants to be sure the cervix is
clear. This greatly reduces the chance for infection to be introduced to the mother.
Monitored intermittently with a fetoscope or Doppler and she will not be asked to adjust her position at all in order
to accomplish this. Midwives are famous for being able to get into any 'twister' position to check on the baby. This
minimizes interruption to the mothers' natural birthing process and does not disturb her movement or sense of
comfort.
Left to labor in her own comfort working with her partner and getting as much support from her Midwife as she asks
for. She can labor in the tub or shower, on the bed or floor. She can follow her body to the position which she is
led to. Her innate cellular knowledge of how to birth is deeply honored and respected. She will be trusted and
heard, held and encouraged gently. She will have the support of other women around her who help her let go and
give into and go with the surges and movements she feels. Her Midwife will use her heart and hands to augment
the birth by maintaining a safe, comfortable environment. Under these conditions, many women do not actively
push their babies out. Instead it is felt and seen as an expulsion of the baby by the uterus. The Midwife does not
manage or direct the pushing if there is any or the expulsion type of birth. She may ask the mother to pant
through some contractions if she thinks it will help the mother to stretch her tissue before allowing the baby to
pass.