Part 1: Approaches to Maternity Care and Birthing

There are two modes of how the United States approaches maternity care for mamas / families / babies. The threads of this are cultural and so important to know. We’re all swimming in it. This culture feels like home to us, it’s all we know, it’s like the ocean to us as fish. And it deeply informs how we think and feel about certain processes like birth. Unfortunately, not everything the culture tells you is true. In fact, a lot of is it partially or completely false. It really comes down to how the culture views the body of women. How do we in the United States view a woman’s body? There are so many answers to that question that I won’t address here cause I’m focusing on birth, yet the roots of how we process birth lie in these cultural myths. I can’t stress how important this information is, any way you look at it.

What I’m introducing in this post is two models of care available in this country for maternity care. The midwifery (or humanistic) model of care and the techno-medical model of care are what we have access to. Many people don’t know about or understand the midwifery model of care. I know I had no idea about it until a few years ago. I grew up swimming in the medical model. Disclaimer right up front: I’m not going to say who or what is better. My honest and transparent opinion is that they both have their place, and if they could learn from each other and use the wisdom and skill of the other side, we would have an incredibly high rate of success. Unfortunately, we seem to still be stuck on the “this is the right side” camp, from both ends. So I’m going to break it down, and you get to choose what feels right for you and your family, from both parties. Mix it up and make a maternity care cocktail, that’s the way I believe progress happens.

The Midwifery Care Model:
* Female centered. Birth is something women do, not something that happens to them. The woman is the central agent of this primal, ancient process of life bringing in life
* The essential oneness of mind and body and the power of the woman in the creation of new life is acknowledged and honored
* Pregnancy and birth are naturally healthy processes and mother and baby are an inseparable unit. The emotions of the mama have a very real impact on the baby’s health
* Longer visits with professional allowing for more questions / knowledge sharing
* Emphasizes the importance of nutrition as the best way to prevent common pregnancy complications. Emphasis on the importance of support and empathy as a way to minimize unnecessary interventions
* 85-95% of healthy women will safely give birth without surgery or instruments. Medical intervention is inappropriate unless necessary. Labor has its own rhythms and is not expected to conclude with any sort of time limit. It starts and stops, slows down and can still be normal. Women are allowed to move around freely, drink and eat, and be sexually playful with their partner if it helps the labor progress.
* Recognizes medical intervention is sometimes necessary and should be applied in emergency situations. It also maintains that intervention can be harmful if it’s used purely for convenience of profit.

The Techno-Medical Care Model:
* Newer to the world scene (the midwifery model is ancient compared to the medical model)
* A product of the industrial revolution and male-driven. An assumption that the body is a machine and the female body in particular is a machine that is full of defects and shortcomings
* Pregnancy and labor are seen as illnesses which must be treated with medications and medical equipment to keep the mother and baby safe
* Some medical intervention is necessary for every birth. Once labor begins, birth must take place within 24 hours
* Mind and body are separate. Emotions is of little importance during the birthing process and is used for marketing and making the sale
* Women who give birth vaginally are usually hooked up to electronic fetal monitors, IV tubes, and other devices. Eating and drinking is usually limited or prohibited. Labor pain is seen as unacceptable and medications or anesthesia are recommended
* Episiotomies (the surgical cut to enlarge the vaginal opening) are routinely performed out of the belief that birth might be impossible or harmful to the mama or baby without it
* The woman becomes a passive object representing a barrier to the baby’s passage to the world. Women are treated as a group in the model with less consideration for individual preferences and needs

What about the gray zone?  There is always a gray zone. There are many people whom function within the medical system whom may have a midwifery approach to maternity care. It’s not as simple as those lists above (though separating things into “this or that” categories can help put things in perspective at times). Some doctors whom work within the medical model can employ midwives and practice with the midwifery model in mind. Many hospitals have midwives as part of their team. On the reverse side of that, there are some midwives whom are trained in the midwifery model but end up practicing largely from the medical model due to their place of employment and the influences of those systems. You’ll need to look at more than superficial questions to get your answers when this gray zone is in question. You can do this by talking to other women about their care providers, reading reviews of the practitioner, noticing if your feelings are welcomed and validated during prenatal visits, and even asking for statistics or numbers of the person and organization you’re considering. Numbers don’t lie.

Nutrition: This is one of the biggest rubs between these models. The midwifery model asserts that this is one of the MOST important aspects of prenatal care. Through eating and drinking well, you will give yourself and your baby some of the best pregnancy insurance possible. Some of the most common complications such as toxemia can be decreased or even prevented through good nutrition and stress management (not always as easy as it sounds with the lifestyles we all have going on). These statistics have been studied and researched and proven, yet somehow the big systems ignore them. The reason for this still stumps me.

Metaphor: A way to consider this is that people who garden know that you must nourish the soil if you want a healthy plant. You must water the plants, especially when the seeds are germinating and sprouting, and they should be planted in soil that is nutrient rich. Why would nutrition matter less in the creation of a baby than it does in a  young plant? It’s crazy talk to think it doesn’t matter, of course it does! People whom work with plants and animals know that to give life you must be well fed and given enough water and salt to give the best chance of survival to the young. Humans are not exempt from this principle. We’ve come to believe that we can live on soda and candy and chips with an occasional canned vegetable, but I truly believe that’s setting us up for difficulty. Pregnancy and birthing is one of the most physiologically intensive processes anyone will ever go through. I truly believe we need the support of thriving physical health to make it easier.

What’s coming next: This part 1 has been to introduce the models of care that are available. Part 2 will dive into some of the specific pieces that go with the medical model (typical interventions or services offered). I’ll discuss the intentions and reasonings for the opportunities the medical model gives, and the possible benefits and risks associated with each intervention. To be specific, I’ll cover these tools that are often used (sometimes automatically without much explanation): ultrasound, chromosome sampling and screenings for abnormalities (such as testing for Down syndrome), screening for Gestational Diabetes test / Beta strep, and Prenatal Rhogam. These are all offered in the pregnancy / prenatal time and often have an impact on the woman and the baby. Sometimes this impact is stressful or harmful, and the tests are often not completely necessary.

Informed Consent: In another later post I will cover interventions that are offered and used during the birthing process (such as epidurals, episiotomies, forceps and vacuums, etc). And finally, in my next post, I will discuss informed consent. This concept of consent is really what this is all about. Consent is what everything is about in our world right now. Sex and rape, relationships, boundaries, agreements, marriage, professional life, the list goes on. The questions are: what are we agreeing to? Have we been fully informed? Have we been given the chance to say a firm yes or no? Have we been given the time to figure out the answer? Everything I’ve described above and will explain in future posts has its place in the world of pregnancy and birthing. With informed consent, it is the decision of the family and the woman about her body and her baby. Without informed consent, things get messy and people end up being left with negative feelings and undigested experiences that can have ripple effects for years. The bottom line for me is that we need to treat our women, families, and babies with respect. Everything else will come in its due time.

Until next time, with love, Alicia


About Alicia Patterson

Alicia Patterson is a Psychotherapist / Dance Movement Therapist, Birth Doula, Energy Worker, Dance and Yoga Facilitator in the Boulder / Denver area.
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