When determining who will be your care provider throughout pregnancy and birth, there are many factors you should consider. You will want to consider any risk factors that you may have as well as the type of experience that you wish to glean from birth. There are two major models of care when it comes to childbirth: Midwifery and Medical.
The Midwifery Model of Care has a woman-centered focus. Birth is considered a natural and normal process where the woman should be supported. A midwife will support a woman and the natural rhythm of her birth physically, emotionally, and spiritually. She will seek additional medical expertise and intervention when it is truly necessary. She will also allow plenty of time during prenatal appointments for discussion and will endeavor to develop a trusting relationship between you.
The Medical Model of Care has a pathological focus. This means that the doctor’s focus will be on preventing, diagnosing, and treating complications. Medical training involves the use of tests, distributing medication, use of medical interventions, and surgery. This model of care is also known for it’s “drive-by” style prenatal appointments.
Types of Midwives
- Certified Nurse-Midwife (CNM)
- In the United States this is the only type of Midwife that can legally practice in all 50 states
- CNM’s are trained in the Nursing and Midwifery and is certified by the American Midwifery Certification Board. A CNM may have a bachelor’s degree in Nursing and a master’s degree in Midwifery
- Certified Professional Midwife (CPM)
- In the United States national certification is available for CPMs but licensure is given on a state level. Currently CPMs are legally authorized to practice in 28 states.
- Certified Midwife (CM)
- CMs are currently legally recognized to practice in New York, New Jersey, Rhode Island, Delaware, Maine and Missouri
- CMs have a bachelor’s degree in a non-nursing field and a master’s degree in Midwifery. CMs are certified by the American College of Nurse-Midwives
- Traditional/Community Midwife
- A traditional midwife has chosen to become certified or licensed. There could be many reasons for this, but one is that there are some women (midwives and expectant mothers) who are simply uncomfortable of the certain care practices that are required for the midwife to maintain their licensure.
- Family Practice Doctor
- Your normal family doctor can care for you before, during, and after pregnancy as well as during delivery
- Family Practitioners have completed medical school and a 4 year residency program in family medicine
- An OB/GYN is a doctor that specializes in pregnancy, childbirth, and a woman’s reproductive system
- An OB/GYN has completed medical school and a 4 year residency program in obstetrics and gynecology
- A Perinatologist is maternal-fetal medicine specialist and works with high-risk pregnancies
- A Perinatologist has completed the same education as an OB/GYN plus 2-3 years in a maternal-fetal medicine fellowship program.
When choosing your healthcare provider you should be aware that many may sway somewhere in the middle of the the models of care. A midwife may take a more medicalized approach and an obstetrician may take a more woman-centered approach. That is why it’s important to interview individual care providers to know if they are a good match for you.
Some questions you may want to ask:
- What are your general views on birth?
- What is your c-section rate?
- What hospitals/birth centers do you have privileges? Do you do home births?
- What are your routine care practices? Why do you think they are necessary? Can I forgo any of them? To you provide alternatives?
- Do you clients that wish to have a med-free birth typically succeed?
- What is your stance on ultrasounds?
- What is your stance on cervical checks?
- How do you handle pregnancies that have gone “past due”?
- Will I be seeing you at all my prenatal appointments? Who would be attending the birth if you are not available? Will I be able to meet them beforehand?
These questions are just a starting point to get the conversation flowing. Ask questions about what matters most to you and your situation. Try to find someone with a similar philosophy of birth as you do and who respects your decision. Simultaneously you should be considering where you want to give birth. I will delve into what your options are for that next week. Until then,
Have a blessed week,