Models of Maternity Care

BY OBOS

PREGNANCY & BIRTH CONTRIBUTORS | APRIL 2, 2014

Before choosing a care provider and place of birth (the two usually go hand in
hand), it is helpful to understand the two main paradigms in maternity care
education and practice, described as the midwifery model and the medical model.
These terms derive from the kinds of care physicians and midwives have
historically provided.
The classic midwifery model is based on the assumption that most pregnancies,
labors, and births are normal biological processes that result in healthy outcomes
for both mothers and babies. It focuses on maximizing the health and wellness of
a woman and her baby, identifying and managing medical problems early on, and
attending to the emotional, social, and spiritual aspects of pregnancy and birth.
Midwifery care seeks to protect, support, and avoid interfering with the unique
rhythm, character, and timing of each womans labor. Midwives are trained to be
vigilant in identifying women with serious complications. Medical expertise and
interventions are sought when necessary but are not used routinely.

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A strict medical model of care focuses on preventing, diagnosing, and treating the
complications that can occur during pregnancy, labor, and birth. Prevention
strategies tend to emphasize the use of testing, coupled with the use of medical or
surgical interventions to avert a poor outcome.
Medical expertise and interventions are vital for women and babies with
complications. However, routine interventions on women at low risk of problems
can actually lead to problems. Training in the medical model does not typically
focus on developing skills to support the natural progression of an uncomplicated
birth.
Although it is crucial to understand the differing philosophies and training
among practitioners, it is also important to note that the letters after someones
name do not tell you much about her or him as an individual. Some doctors have
attitudes, styles, and approaches that fit the midwifery model, and some
midwives incorporate the medical model that is more common for doctors. For
this reason, some people believe it is more accurate to refer to the different
models of care as a physiologic model (that is, care in accord with the normal
functioning of a womans body) versus an interventionist or pathology-driven
model.
The midwifery model and medical model also give rise to two different ways of
organizing maternity care systems. In most industrialized countries, midwives

coordinate the care for the majority of childbearing women and collaborate with
obstetricians or other specialists when a woman has medical complications or
risk factors. Healthy women often give birth in midwife-led hospital units or birth
centers or at home.
In contrast, in the medical model prevalent in the United States, doctors manage
the care of most women, almost all of whom give birth in hospitals. When
midwives do provide the care, they are usually supervised by doctors and working
under medical rather than midwifery protocols. For more information on
problems with the kind of care most women in the United States receive.