Making Your Best Decision
Choosing your maternity care provider is a personal decision that takes a great deal of thought. In addition to considering their education and expertise, it is essential to ask about a providers approach to care and how they will work with you to make decisions. These factors can have a major impact on the quality of your care.
There are two approaches to maternity care, the midwifery model of care, and the medical model of care. Naturally, the midwifery model describes the practice of most midwives, and the medical model describes the practice of most doctors. However, many caregivers combine elements of both. It is possible, but less common, to find doctors whose practice most closely resembles the midwifery model of care and midwives whose practice most closely resembles the medical model.
Thinking about these different views can help you to understand your own values and ideas about pregnancy and birth, and can help you select a caregiver who is compatible with your needs. Many women have a clear preference for one or the other of these models.
Midwifery Care Model vs. Medical Care Model
Our midwifery services are recommended for women who desire a natural approach to pregnancy and birth. We believe that womens bodies are finely tuned to do the work of growing and birthing healthy babies. We believe our role in your care is partner, counselor and facilitator, rather than expert in charge. We expect women to take active roles in this partnership. This includes a commitment to healthy eating and regular exercise and avoiding alcohol, tobacco, and other harmful substances. It also means a desire for learning and exploration into the journey of birth and parenting.
Midwifery Model of Care
- Focus on health, wellness, prevention
- View labor and birth as normal physiologic processes
- Lower rates of intervention
- Mother gives birth
- Care is individualized
Medical Model of Care
- Focus on managing problems and complications
- View labor and birth as dependent on technology
- Higher rates of intervention
- Doctor delivers the baby
- Care is routinized
When is Midwifery Care Not the Best Choice?
Because midwifery care focuses on health and wellness and prevention of problems, there are some situations where midwifery care is not in the best interests of the woman or her developing baby. In these instances, women should be under the care of a physician. These conditions include the following:
- You are 28 weeks pregnant and have not received prenatal care during this pregnancy
- You have had 3 or more cesarean sections or 1 classical cesarean section
- You have had 2 or more pregnancy losses beyond 14 weeks gestation or “incompetent cervix” or “cerclage”
- Chronic hypertension – high blood pressure that exists prior to pregnancy
- You have had pre-eclampsia in 2 or more pregnancies
- Pre-existing diabetes or having been told that you have “borderline diabetes” and are taking medication
- You have had gestational diabetes that required the use of medications or insulin in 2 or more pregnancies
- Obesity, if your starting BMI is greater than 40
- You smoke more than 10 cigarettes a day and are unwilling to participate in a cessation program
- You have hyperthyroidism
- You have a seizure disorder that requires the use of medications
- You have asthma that requires daily medications or has required hospitalization and intubation
- You are positive for HIV or hepatitis B or C
- You have a blood clotting disorder that requires the use of blood thinners
- You have active kidney or liver disease
- You have mental illness requiring the use of antipsychotic medications (this does not include the use of SSRIs for anxiety and depression)
- You have a chronic condition which requires the use of daily narcotics or benzodiazepines
- You have a significant autoimmune disease that has a high potential for developing complications in you or your developing baby (such as systemic lupus erythematosis)
- You have a blood clotting disorder or have a history of deep vein blood clot
- You have cardiac disease or have had a stroke
- You have cancer and are receiving radiation or chemotherapy treatments
If any of the above conditions apply to you, we encourage you to find a primary care OB/GYN as soon as you know you are pregnant. For help finding a physician right for you, visit GHS Physician Finder or call 1-844-GHS-DOCS.