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Differences Between Obstetricians and Midwives

By February 16, 2011No Comments

by: Kristin Maresca, Labor Doula

As I sat at home this past Friday evening re-watching The Business of Being Born in preparation for The Motherhood Center’s Saturday viewing of the film and subsequent panel discussion, I could not help but reflect intently on the similar process that I took during the birth of my daughter almost two years ago. The journey I traveled through pregnancy and into motherhood was marked by a crooked path, anxiety, and countless forks in the road. I had to call upon my knowledge and innate sense of what it meant to birth as my husband and I prepared for the birth of our daughter.

When I found out I was pregnant, I immediately put a post onto Facebook asking friends and colleagues for Obstetrician recommendations. I initially signed on with a large, popular practice in a posh area of Washington, DC, and was rotated through a series of doctors and subjected to ultrasounds, blood work, and a series of other tests over the first few months of my pregnancy. I never questioned the necessity of the tests, the long-term effects of ultrasounds, or inquired into the philosophical viewpoints on birth that the doctors subscribed to. I couldn’t help but feel sometimes, however, that I was one of the many pregnant female cattle being shuttled through their offices, each of us being put through the same tests, asked the same questions, and that we might as well even have the same faces. I also noticed something unmistakable, that I was being treated like I didn’t have the intelligence or expertise to understand and make decisions about my pregnancy.

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One Sunday afternoon, my husband and I walked into a comfortable community space in an Episcopal Church in Takoma Park, MD for a meeting of Birth Options Alliance, a local, homegrown organization dedicated to providing evidence-based information about pregnancy, childbirth and parenting and advocating for accessibility of a full range of caregiver and birth location options. We sat down in a circle, engaging in small talk with the other expectant mothers and their partners. That day proved to be the beginning of journey to take back my pregnancy and birth, an experience that strongly informed my decision to become a labor and birth assistant, also known as a doula (something I’ll talk about in an upcoming blog post).

OB? Midwife? What’s the Difference?

Soon after that initial meeting, my husband and I signed up for a childbirth education class and switched providers. We wanted a primary care provider who would be supportive of our birth choices, respect our intelligence and ability to make informed decisions about our pregnancy and birth process, and who would support me as a woman who trusted my body’s innate capability to birth. We signed up with a midwifery practice that attended birth in the hospital.

There exist two models of prenatal care in the United States: the medical (often called obstetrical) model and the midwifery model. The former, as the name implies, is generally subscribed to by obstetricians. Medical training for maternity care emphasizes the identification and management of medical risks and complications. Obstetricians are trained surgeons. The medical model tends to focus on problems and physical matters at the expense of the normal childbearing process and emotional concerns. Numerous tests and treatments may be recommended in order to rule out “problems”, to make sure that nothing is wrong (when there are no indications that anything may be wrong in the first place), and to try to impose control of an otherwise normal life process.

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The midwifery model of care refers to the approach that midwives take towards childbirth. Like obstetricians and family physicians who attend births, midwives provide prenatal care, care during labor and birth, and care after the birth. The primary differences between the two models are, in general, midwives give priority to providing good information to women, involving women in decision-making, and providing flexible and responsive care, rather than routine care that is not individualized. Many work to avoid unnecessary tests and treatments; and women under the care of midwives typically are less likely to have a cesarean, an episiotomy, and other interventions than women receiving care from doctors. Some midwives provide continuous support throughout labor and birth, which has many benefits for women, infants, and families. Midwives attend births in a variety of locations, including hospitals, freestanding birthing centers, and homebirths.

Basically, doctors and midwives both have a place in the world of pregnancy and childbirth. In high-risk pregnancies and when there is a complication during birth that requires significant medical intervention, medical doctors play a critical role in saving the lives of moms and babies. In the vast majority of pregnancies and births; however, a midwife is not only capable but also better suited to support the natural childbirth process.

These differences aside, the reality is that the prevailing attitude in the United States towards birth has resulted in women feeling more comfortable in the hospital setting, and when medical personnel – trained medical doctors – are attending the birth. Until this changes – and I hope that it does for the sake of moms and babies – we need to make sure that women understand and are educated about the birth process so that they can make informed choices about their birth. Doctors are not the problem; the issue is that we have convinced women that birth isn’t a natural, normal, physiological process and that it requires interventions to safely work (which is particularly problematic when research has shown that those very interventions are often what lead to life-threatening complications in the first place). Again, I need to stress that not all interventions are always bad, but they need to be used judiciously, selectively, and conservatively. Women must also be recognized as being strong enough and smart enough to make informed decisions during pregnancy and birth. I believe these changes will result in improved birth outcomes, lower medical costs, and more fulfilling birth experiences.

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