The first blog

Wellspring Childbirth

Welcome! I am trying my hand at blogging. My goal is to write about the current issues surrounding pregnancy and birth for those who are looking for a more natural, physiologic and peaceful experience during this time in their lives. Birth does not have to be sterile, frightening or traumatic.

What is natural childbirth?

Natural childbirth is the act of giving birth without the use of any pain medication or medical interventions. Many women chose natural childbirth because they feel it offers the safest experience for both mother and baby. Read more about why to choose a natural birth at birthingnaturally.net

Two models of care

The Medical Model of Care typically approaches birth as a risky process which requires management of risks through the use of technology and medication. Care is routine for all women (office visits are short, leaving little time to make personal connections, ask questions, etc). There are high rates of interventions (induction, augmentation, epidurals, cesarean section, etc). Many women feel that their care provider is "in charge" of the process and they have little power, control or ability without medical assistance.

The Midwifery Model of Care typically approaches birth as a normal, physiologic process in which most women can successfully give birth with out the use of interventions. This model provides individualized care to each mother and care providers typically spend ample time at each prenatal visit to to get to know the woman and discuss her concerns or fears. Women, with the proper support and access to comfort measures, are are free to act as powerful birthers of their own babies.

While, most midwives fall into the category of offering the Midwifery Model of Care, not all function in the same way. The home birth midwife has the most flexibility in how she cares for a woman, while those who partner with physicians and attend births in a hospital, can be restricted in the type of care and service they provide. Similarily, some physicians offer care that is more like the Midwifery Model than the Medical Model. My next post will discuss how to ask the right questions to find out how your care provider (or a potential care provider that you are interviewing) feels about birth.

Here is a great review of research on the difference between the two models of care (from the Cochrane Library:

Midwife-led versus other models of care for childbearing women

Midwife-led care confers benefits for pregnant women and their babies and is recommended.In many parts of the world, midwives are the primary providers of care for childbearing women. Elsewhere it may be medical doctors or family physicians who have the main responsibility for care, or the responsibility may be shared. The underpinning philosophy of midwife-led care is normality and being cared for by a known and trusted midwife during labour. There is an emphasis on the natural ability of women to experience birth with minimum intervention. Some models of midwife-led care provide a service through a team of midwives sharing a caseload, often called 'team' midwifery. Another model is 'caseload midwifery', where the aim is to offer greater continuity of caregiver throughout the episode of care. Caseload midwifery aims to ensure that the woman receives all her care from one midwife or her/his practice partner. By contrast, medical-led models of care are where an obstetrician or family physician is primarily responsible for care. In shared-care models, responsibility is shared between different healthcare professionals.

The review of midwife-led care covered midwives providing care antenatally, during labour and postnatally. This was compared with models of medical-led care and shared care, and identified 11 trials, involving 12,276 women. Midwife-led care was associated with several benefits for mothers and babies, and had no identified adverse effects. The main benefits were a reduced risk of losing a baby before 24 weeks. Also during labour, there was a reduced use of regional analgesia, with fewer episiotomies or instrumental births. Midwife-led care also increased the woman's chance of being cared for in labour by a midwife she had got to know. It also increased the chance of a spontaneous vaginal birth and initiation of breastfeeding. In addition, midwife-led care led to more women feeling they were in control during labour. There was no difference in risk of a mother losing her baby after 24 weeks. The review concluded that all women should be offered midwife-led models of care.

Hatem M, Sandall J, Devane D, Soltani H, Gates S. Midwife-led versus other models of care for childbearing women. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD004667. DOI: 10.1002/14651858.CD004667.pub2.