Obstetrics vs Midwifery
What actually is the difference between the obstetrics model of care and the midwifery model of care? For many people, this question is not being asked because they don't even know that there is another option outside of obstetric care. In fact, there's a huge percentage of people out there that have no idea what a midwife is. I've found myself very often explaining to students and clients the difference between a midwife and a doula, which is a far greater difference than that of a midwife and an OB.
To first cutout any confusion around this topic, a midwife is a trained professional who assists women in childbirth. For all intents and purposes, she is a doctor who specializes in delivering babies, primarily outside of a hospital setting. In some cases, she may have special privileges and certification that allow her to work at a hospital. Unlike an OB, though, she is trained to assist the childbirth process outside of the medicalized hospital system, without the use of unnecessary medical devices and procedures.
It is this use of medical procedures that is probably the greatest difference between obstetrics and midwifery. What we first have to understand in evaluating these models of care is the training and background of the professional. Midwives are trained, first and foremost, in assisting the childbirth process and delivering babies safely. They are experts in childbirth, specifically childbirth outside of a hospital. They are only then trained in certain medical procedures for use in the event of truly life-threatening emergencies. OB's, on the other hand, are trained, first and foremost in medical procedures. Before becoming OB's, they go through many rigorous years of medical school. They are trained to save lives or correct physical problems through the use of medical devices and life-saving interventions. Only after years and years of this very medical training do they then make a choice to enter into an obstetrics specialty, whereby most of their years of learning has no place given the nature of childbirth versus illness or injury.
So if this is the case (that midwives are trained in childbirth and obstetric doctors are trained in medical procedures), then why do we have obstetrics at all? And how do you decide which option is right for you? Really it all depends on the status of your pregnancy and your health history. Midwifery care is better for what we call "low-risk pregnancies". Low-risk women have not had any complications during their pregnancy and likely have a health history that is free of any conditions or dangers that might put them or their babies at risk. In this model of care, you'll get lots of one on one time with your midwife while she feels your belly, talks to you about diet and exercise, and prepares you for the childbirth journey. She'll also act as an emotional support system and will be with you throughout most of your labor. In low-risk scenarios, midwives are more appropriate because labor tends to progress as biology intended and there's no need to interfere with unnecessary life-saving medical devices and procedures, which often do more harm than good in low-risk situations.
Obstetric care is better for what we call "high-risk pregnancies". High-risk women often have a pre-pregnancy condition or complications within their pregnancy that deem them to be high-risk and because of that could put them or their baby in danger. In this model of care, you'll get very little time with your doctor who will have an unlimited number of other patients to care for, medical devices will be used to monitor your progress and no additional lifestyle or emotional support will be provided. What you will get, however, is a very skilled doctor surrounded by state-of-the-art equipment, should those dangers arise during your pregnancy or labor. In these cases, labor and delivery usually does not progress without some concern and so medical intervention and supervision becomes necessary. In high-risk scenarios, OB's are more appropriate because they are acting in the capacity for which they were trained: to prevent mortality and correct arising medical issues.
What must be made extremely clear when making your care-provider choice is that you should spend a great amount of time thinking about what kind of experience you would like to have and making that choice based on what is offered. Often I will meet with potential clients who tell me that they want a natural, uninterrupted, unmedicated childbirth experience. And then they tell me that they've chosen your standard OB practice to support them. Although there are certainly some OB's out there who have additional professional training and do support and administer care similar to midwifery care, the vast majority of OB's simply cannot provide this type of service. It's a lot like asking your yoga teacher to teach you pilates; she certainly can try but she's not a pilates instructor. To really learn pilates, you should go to a pilates instructor, not a yoga teach. And so, to really have a natural, unmedicated birth you should choose a care-provider who is skilled in natural, unmedicated birth rather than a care-provider who's been taught only to adhere to a medicalized standard of care.
To learn more about the differences and help choosing the right path for you, come to my FREE talk on Sunday June 12th at 1:30pm at Silverlake Yoga. Midwife and Director of Gracefull Birth Center, Elizabeth Bachner, and I will be speaking on this topic and answering any and all of your questions. RSVP here!