Wednesday, March 31, 2010

Choosing a Birth Care Provider - Which Type?

Some online friends of mine wrote this article for their local paper.  I gave feedback and helped during the editing process, and liked the final product so much I thought I'd share it here on my blog.  I offer it for those of you who are scratching your heads over figuring out how midwives and doctors differ. 

Again, I emphasize that no one type of provider is suitable for all women.  Some women prefer high-tech care with lots of tests and/or an epidural in the parking lot.  Some women prefer low-tech care, with minimal or no tests and birth as natural as possible.  Others want something in between.  There's nothing wrong with any of these types of births as long as you are clear on what you want and why.

Some women prefer that their doctors do all the decision-making, while other women prefer to be partners in their decision-making.  Some women prefer to birth in the hospital, and some prefer to birth outside the hospital (at a birth center or at home).

There no one "right" way to give birth for everyone. But if they explore their feelings, most people find they have ideals about how they want to be treated in pregnancy and birth, how they picture birthing their babies, and what kind of care they are looking for.  When I teach childbirth classes, I always encourage parents to explore the spectrum of possibilities and consider what fits best with their ideals.  In time, they usually find the right path (and provider) for them.

It's important to remember that the care provider's job title does not necessarily mean they practice in that same care model.  In other words, some doctors actually follow the hands-off tenets of the midwifery (physiological) model of care, while some midwives are high-tech and interventive like the medical (technological) model of care.  Although job titles and degree letters give you generalized clue to their practice style and philosophy, it's not a guarantee of anything.  You always have to ask questions.

Readers of the blog know that I tend to favor midwifery (as does the following article; fair warning) and have usually had my best experiences with midwives, but one of the worst experiences I ever had was with a homebirth midwife who was actually a high-intervention OB in sheep's home, no less.  I also have met OBs who are very hands-off and low-tech.You can't tell someone's philosophy solely from their job title; interview carefully to see what their real pattern of practice is like.

I usually suggest that prospective parents interview several types of care providers, including some OBs, some CNMs, and some homebirth midwives.  Reflecting on these interviews usually helps clarify their choices for them.  Most people come away with a clearer idea of the type of care (and care provider) they prefer.

Here then is the article.  I hope you find it helpful.

Choosing a birth provider can be difficult

By Christa Billings and Amy Poe
From the Portland Tribune, Mar 25, 2010
Regarding Peter Korn’s article “Natural birth? Nope, C-Section rates on rise” (Feb. 18), one of the most important decisions new parents are faced with is choosing a birth provider. It is also one of the most difficult and confusing decisions to make.

The truth is that there is no one perfect location or type of provider for all women. We all come to our births with our own experiences, beliefs, personal health and genetics, and each mother has to come to know her own needs in order to choose the most optimal provider and setting for her birth.

There are two basic models of maternity care: the physiological (midwifery) model and the technological model (obstetrics). Each has its own advantages.

The physiological/midwifery model recognizes birth as a natural event. Care is centered on the woman and baby as a pair, and each pair is recognized to have its own set of experiences and unique health considerations. In this model, the birth providers spend a considerable amount of time with the parents, getting to know their physical and emotional needs and providing them with important information on their pregnancy and birth choices.

While the midwifery model emphasizes the partnership between the mother and provider in the birth process, the technological model views the birth provider as the expert whose job it is to control and manage the pregnancy, labor and birth. Normal birth is narrowly defined, and the provider is trained to treat any deviation from normal as a pathology needing intervention. The provider relies heavily on testing, monitoring and technological intervention in assessing and controlling the situation.

Statistically, both models of care can and do result in healthy babies most of the time. The primary differences between the two models are the type of care the mother receives during the pregnancy and her role in the actual birth – whether she is the active decision-maker (in partnership with her provider), or whether she delegates the control of her labor to an expert.

Naturally, it is always important to check the credentials and references of any provider you are considering, be it a direct-entry midwife, certified nurse-midwife, naturopath, family practice doctor, or obstetrician. But it is just as important to understand which model of care the provider practices, and whether that is compatible with your own beliefs about birth.

It’s important to realize that the provider’s title does not guarantee which model of care they practice. Midwives can order the same labs and screening tests as doctors, and some are very technology-oriented. Conversely, an OB-GYN may firmly believe in the normalcy and diversity of birth, and have a low technological intervention rate.

Midwifery care is a natural, holistic and wellness-oriented view of pregnancy and birth. Midwifery care focuses on the pregnancy as normal and healthy, rather than pathological. Most midwives believe in a proactive approach to wellness. They try to prevent complications in the first place by emphasizing healthy behaviors. If complications do arise, they take steps to work with you and your baby to deal with them instead of treating a complication like a disaster waiting to happen.

Time and patience can be one of the biggest benefits of midwifery care. Many doctors have strict time limits for labor, after which a cesarean is performed. Midwives believe that if the mom and baby are not in distress and all vital signs are reassuring, there is no need to hurry a birth. Every woman’s body and birth are different, and not all strictly adhere to a “typical” labor curve. Many babies come out naturally if given a bit more time and patience.

Many women have heard of midwives but are unaware of research showing improved outcomes with midwives. Examples include the interspecialty differences in the obstetric care of low-risk women, on the Web at, and the outcomes of planned hospital birth attended by midwives compared with physicians in British Columbia, on the Web at

Midwives are experts in normal birth, and most births proceed normally, with good outcomes, if allowed a little time and patience. However, sometimes more intervention is needed, and midwives are trained to recognize when intervention or technology is needed. At that time, they have obstetric colleagues to whom they refer their clients, while still following up to assure continuity of care. It is at those times that we can be grateful for the surgical skills and capabilities of our obstetricians and hospitals.

Not only does midwifery care lead to fewer infections, inductions, episiotomies, vacuum/forceps extractions and cesarean sections, but midwives also tend to the emotional, spiritual, and health and nutritional needs of the mother from the start of the pregnancy through labor and birth and for several weeks after the baby is born.

Choosing your type of birth provider is a critical choice in your care. Oftentimes, parents spend more time researching and picking out nursery d├ęcor than they do choosing a provider who meets all their needs. For some women, an OBGYN is the right type of provider and for others it is a midwife. Taking the time to do your research on choosing the right provider for you can have an effect on the outcome of your birth.

Christa Billings of Beaverton, and Amy Poe of


April D said...

As my husband and I are beginning our thoughts on pregnancy this was a great post! Are there any particular questions you'd recommend asking when interviewing potential care-givers??

Erica said...

I am one of those who actually doesn't know what provider to choose. We have two options for a midwife in my area (both CNMs, one at a private practice the others in a hospital birth center). I'd love a midwife next time around. However I had a massive post partum hemorage with my first birth, and very mild GD with my second child (all numbers were fine, both interveinous draws and finger pricking, but i always failed the glucola tests) his birth was fine, and quite easy-though an u/s i requested late pregnancy before an induction revealed low fluids-at about 5-6.5 from day to day. Idk if I SHOULD choose a midwife, I worry over complications. But many of my problems could have been easier if I had been paid close attention to, and I feel as though the midwives seemed better suited to that. All in all, I am just unsure. How does someone in a situation such as myself go about deciding such a thing? thanks

Me said...

Great article, thank you for posting!