July 8, 2016

Understanding the Model of Care : Doctor and the Midwife

This article originally appeared on Mommybites.com, November, 11th 2015.

For many women there seems to be some confusion over the difference between the practice and role of a midwife versus that of a doctor. While there are some overlapping areas for OBs and midwives, such as they both perform yearly well exams, normal obstetric care, and risk assessment for low risk women, a divide becomes more apparent as the approach to care is defined.

Let’s first understand the definition of the the OB/GYN and the midwife

Obstetrician: A physician who delivers babies and is in the practice of obstetrics, the art and science of managing pregnancy, labor and the puerperium, the time immediately after delivery. (1)

You will see your OB/GYN or members of his/her practice throughout your pregnancy, although who your care provider will be at delivery depends on who is on call during your labor. During the labor, the doctor will come in and out to check on your progress and, as the definition above states, “manage” your labor. Obstetrics is also a surgical field, so in the case of a cesarean, it would be your OB that would perform the procedure.

Midwife: A midwife is a trained professional with special expertise in supporting women to maintain a healthy pregnancy birth, offering expert individualized care, education, counseling and support to a woman and her newborn throughout the childbearing cycle. (2)

A midwife works with each woman and her family to identify their unique physical, social and emotional needs. When the care required is outside the midwife’’s scope of practice or expertise, such as being high risk or have preexisting health issues, she would be referred to other health care providers for additional consultation or care. There are also different types of midwives: Direct Entry Midwifes, Certified Professional Midwives, and Certified Nurse Midwives. Depending on their credentials and training, some midwives work in hospitals while others solely attend home births.

Now that we have defined the basic differences of a midwife and an OBGYN, we can look at the methodology of care given. The general approach of an OBGYN is from the medical model which focuses on the pathologic potential of pregnancy and birth. A very basic explanation is; the medical model will do preventative protocols before there may be reason to intervene with interventions. This is one of the major deviation from the Midwives Model of Care which believes pregnancy and labor are normal, natural events that need little intervention. The midwifery approach can be interpreted as more trusting of the process which allows more for a “watch and see and then react” mentality. The application of this model has been proven to reduce to incidence of birth injury, trauma, and cesarean section. (3)

Is there animosity between the two models of care?

Maybe. I know some midwives think OBGYNS are performing some unnecessary routine interventions. These interventions include vaginal exams prior to the onset of labor, full time fetal monitoring, continuous IV fluids or insisting a woman in second stage of labor (the pushing phase) be required to birth on her back instead pursuing a position that is most beneficial and effective for her.

That said, I have not heard many doctors criticize hospital midwives. From my own personal experience interacting with OBGYNS, they are usually respectful of this model of care. The only instance I have encountered resistance to the practice of midwifery is when the topic of home birth is introduced and the midwives in question are no longer their hospital colleagues, but an external caregiver, the home birth midwife.

After exploring the similarities and differences between these two models of care, I hope those embarking on the path to motherhood can get a better understanding of which type of model best fits their individual personality and needs. Neither approach is the “right” choice, per se. It comes down the what the mother is looking for. Just as birth differs from person to person so does the desired type of care. Fortunately, the ultimate goal for both practices is for the mother and baby to be happy and healthy.

1. Academic Dictionaries and Encyclopedias
2 Citizens for Midwives
3. Citizens for Midwives




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