Midwifery vs obstetrics.. how the models differ!

This is an excerpt from Ina May's Guide to Childbirth. (It talks about the difference between the midwifery and obstetrical models. I found it to be very informative and absolutely truthful!):

Sociologist Barbara Katz Rothman was the first to name and describe the differences between the models. She pointed out that the midwifery model of care is female-centered. Within it, birth is something that women do- not something that happens to them. The birth-giving woman is the central agent in the ancient drama of life bringing forth new life. The midwifery model of care recognizes the essential oneness of mind and body and the power of women in the creation of new life. The midwifery model of care conceives of pregnancy and birth as inherently healthy processes and of each mother and baby as an inseparable unit. According to this model, the emotions of the woman have a very real impact upon the well-being of the baby. When the woman's emotional needs are filled, there is less risk for the baby. The reality is that the baby has no choice but to feel what the mother feels. Prenatal visits within the midwifery model tend to be much longer, allowing for more questions to be answered than in prenatal visits in the medical model. The midwifery model of care recognizes the importance of good nutrition as the best way to prevent the most common complications of pregnancy. It emphasizes the importance of companionship and encouragement during labor as a way to minimize techno-logical intervention in the birth process. It does not impose arbitrary time limits in physiological processes.

Good research shows that when the midwifery model of care is applied, between eighty-five and ninety-five percent of healthy women will safely give birth without surgery or instruments such as forceps and vacuum extractors. Within the midwifery model, medical intervention is inappropriate unless it is truly necessary. Labor has its own rhythms, so it is not expected to conclude within any rigid time limit. It can start and then stop, speed up or slow down and still be normal. A laboring woman may move around freely, drink, eat, and be sexually playful with her partner within this model (if that is what best stimulates her labor). All of these activities help labor to progress. The midwifery model of maternity care, of course, recognizes that medical intervention is sometimes necessary and that it should be applied in these particular cases. At the same time, it maintains that medical intervention may be harmful when it is used purely for convenience or profit.

The techno-medical model of maternity care, unlike the midwifery model, is comparatively new on the world scene, having existed for barely two centuries. This male-derived framework for care is a product of the industrial revolution. As anthropologist Robbie Davis-Floyd has described in detail, underlying the technocratic mode of care of our own time is an assumption that the human body is a machine and that the female body in particular is a machine full of shortcomings and defects. Pregnancy and labor are seen as illnesses, which, in order not to be harmful to mother or baby, must be treated with drugs and medical equipment. Within the techno-medical model of birth, some medical intervention is considered necessary for every birth, and birth is safe only in retrospect. According to this model, once labor starts, birth must take place within twenty-four hours.

Mind and body are considered to be separate within the techno-medical model of birth. Because of this, emotional ambiance is of importance only when it comes to marketing the service. Where the techno-medical model of birth reigns, women who give birth vaginally generally labor in bed hooked up to electronic fetal monitors, intravenous tubes, and pressure-reading devices. Eating and drinking in labor are usually not permitted. Labor pain within this model is seen as unacceptable, so analgesia and anesthesia are encouraged. Episiotomies (the surgical cut to enlarge the vaginal opening) are routinely performed, out of a belief that birth over an intact perineum would be impossible or that, if possible, it might be harmful to mother or baby. Instead of being the central actor of the birth drama, the woman becomes a passive, almost inert object-representing a barrier to the baby's eventual passage to the outside world. Women are treated as a homogenous group within the medical model, with individual variations receding in importance.

The techno-medical model of care has been dominant for a century in North America. By the 1920's the United States and Canada had become the first societies in human history to do away with midwifery only to find out some decades later that women still wanted midwives and that some (like my partners and me) would reinvent midwifery if they had to. Many people share the goal of reclaiming midwifery and ensuring that in the not-too-distant future there will be enough midwives in Canada and the United States that every women who wants one can have one. Even though midwifery is legal in the United States and Canada, midwives still attend fewer than ten percent of all births in each country. These percentages are far below those of the nations of western Europe and the rest of the world, where midwives attend the vast majority of all births. More than seventy percent of babies born in the countries with the lowest rates of maternal and newborn deaths are born with only midwives-no physicians-in the birth room. In Germany, a federal law ensures that a midwife must be in attendance at every birth-even in cases when an obstetrician must perform a cesarean section or an instrumental delivery.