An Exploration of Whole Woman Care during Pregnancy
Women currently have a spectrum of childbirth options ranging between unassisted natural homebirth, and elective c-section. Somewhere between those two extremes lie two models of care generally called the Midwifery Model of Care , and the Obstetric Model. To compare the two, we can examine them in context of the five areas of health: Physical Health, Emotional Health, Intellectual Health, Social Health, and Spiritual Health.
When compared in the arena of whole wellness, it becomes clear that the Midwifery Model of Care is preferable for low risk pregnancy.
The first area of health is Physical Health – taking care of our physical body.
Overall, both models do a good job ensuring the physical health of the mother and the baby, with only very slight (and highly argued) differences in mortality and morbidity rates. The main difference between the models, in this area, is how safety is approached. In the Obstetric Model potential threats to a woman’s physical health during pregnancy and childbirth are the main focus. Obstetric Model practitioners routinely examine and evaluate for any signs of disease or distress, undermining the idea that a woman’s body is capable of carrying her baby successfully. During the birth, a woman is actually physically harmed; by injection, restraint, starvation, etc… under the premise that she will be more ready in the rare case of emergency.
The Midwifery Model of Care, in contrast, begins the pregnancy by verifying signs of normalcy and reassuring a woman of her body’s ability to carry her baby to term. During labor, a woman with midwifery care will not be needlessly harmed, but will be supported to work with her body in an environment where the expectation is that “normal” will proceed as usual. A midwife is not unprepared for emergency, though, because the Midwifery Model of Care demands the ability of the midwife to perform all lifesaving skills in nearly identical ways to those found in a hospital birthing suite.
The second area of health is Emotional Health – respecting and managing emotions.
This area shows even more contrast between the two models of care. Emotional health is largely ignored in the Obstetric Model, with the focus almost solely on the physical aspect of childbirth. Negative emotional issues are viewed as not significant to the birth process. An Obstetric Model practitioner may be sympathetic to a woman’s emotional turmoil, but rarely connects those emotions to issues during pregnancy and childbirth. During pregnancy the special, first-time moments are often lost in the rush of the 15 minute appointment. At birth, mother and her family are generally left alone to deal with the emotional turbulence of labor while the medical practitioners rely on machines, in different rooms, to tell them the status of the patient. After the birth, the important emotional bonding between mother and baby is interrupted by unnecessary intervention and separation.
The Midwifery Model of Care, conversely, views the emotional health of pregnancy and childbirth on nearly equal ground with physical health. During pregnancy, a midwife is aware of the importance of each emotional milestone, and takes care to allow plenty of time for each woman and family to fully experience the wonder of her growing baby. At birth, a midwife is with a woman to help her navigate the emotional ups and downs of labor, and will recognize a negative emotional issue as a possible hindrance to progress. A Midwifery Model of Care practitioner is trained to address these issues to help a woman to move past them and birth her baby. After the birth a midwife is able to put off any unneeded interventions until the mother, baby, and family have been able to bask in the amazing splendor of the moment. Clearly, the Midwifery Model of Care does a better job of caring for a woman’s emotional health.
The Obstetric Model does not place an emphasis on enriching a woman’s intellectual understanding , preferring instead to deliver neatly packaged bits of information designed to guide a woman down their prescribed path. Options that are discussed are given with bias, and alternative views are largely ignored. Some practitioners even prefer that a woman does not attempt to learn about her pregnancy and birth, lest she attempt to contradict his routines.
The Midwifery Model of Care encourages women to explore all possibilities and become truly educated about the options. A midwifes office usually has a learning library, and women are expected to make educated decisions about their own care. Midwives are generally very supportive of a woman’s personal choices because they know that education is an important piece of a successful birth. This knowledge makes Midwifery Model of Care a better choice for women interested in enriching their intellectual understanding.
Next there is Social Health – learning how to communicate, building confidence in and trust in one’s self.
The Obstetric Model can be socially challenging because medical providers sometimes speak over a woman’s head, or rely mostly on monitors to assess a patient’s progress. This can leave a void in a woman’s social center, and she might feel removed or unimportant in the social sphere of her own care. This is poignantly demonstrated in the pushing stage of labor where, in the Obstetric Model, a woman is told by her provider when she should, or should not push, and encouraged to ignore her own instinct.
In the Midwifery Model of Care, the pregnant woman is the social center of care. She is relied on to convey her feelings and progress, and in the above example, is the director of her own pushing stage. The Midwifery Model of Care supports her communication and her trust in herself, making it the preferable choice for social wellness.
Lastly is Spiritual Health – exploring a relationship with the divine, and discovering a sense of greater purpose.
Spiritually, the Obstetric Model is silent. Childbirth is viewed as a clinical routine.
In the Midwifery Model of Care, pregnancy and childbirth are embraced as deeply spiritual events, and a woman is encouraged to communicate with her divinity in order to bring about the changes in her mind and body that need to happen for a successful transition into motherhood.
In summary, while both the Obstetric Model and Midwifery Model of Care provide excellent care in regard to the physical wellbeing of the mother and baby, the Midwifery Model of Care provides superior care for the whole person, and addresses all areas of wellness. This makes the Midwifery Model of Care the best choice for women with uncomplicated pregnancy.
copyright Sarah Foster 2012