On the whole, midwives tend to fall under the midwifery model of care (hence the name), and obstetricians fall under the medical model of care. However, there are certainly many individual exceptions to this, so it’s important to get to know an individual provider and his or her beliefs rather than assume. Midwives working as part of a group practice are often beholden to an obstetrician, or were themselves trained under the medical model, or have to follow hospital protocol regardless of their own personal preferences. And there are certainly obstetricians and family doctors that lean more toward a midwifery model of care in their work.
Which Model Is Right?
God designed our bodies beautifully. His design for opening the female body and birthing a baby works, and it works well. We know that, biologically and from research, when we follow that design as best as possible, things are ideal for mother and baby. However, because of original sin, we live in a world that is not always ideal. Complications arise, sickness exists, and pregnancy and birth are not easy. What was designed perfectly is now subject to the effects of sin, and outside interventions may indeed be needed.
We can trust that God designed our bodies well and expect our births to follow suit, but we can also recognize that sometimes complications arise. Expecting that birth will be complication-free, allowing it to happen according to its design, and making choices toward that end makes sense, but so does having an experienced, watchful provider with us, should intervention truly be needed. We can certainly see God’s hand in any necessary interventions to help a mother and baby stay healthy. We can even allow these unexpected difficulties and interventions to become redemptive, joining us with Christ and his work on the cross.
Making the Choice
You will need to decide for yourself what model resonates with you and your specific situation. Where would you feel more peaceful? Which philosophy most aligns itself with your experience, temperament, and faith? Which philosophy has better outcomes from a physical, emotional, mental, and spiritual standpoint? Are there health complications or anomalies with the current pregnancy that you need to consider? How does your history play into the decision? Are there women you know who have had great birth experiences? Whom do they use? There is no cut-and-dried answer. Every woman is unique, with a unique set of circumstances.
What we can say, though, is that you should choose the provider who best fits your beliefs, circumstances, and family. This means you should never be afraid to interview different providers, ask questions, and switch when necessary. If a provider is hesitant, dismissive, too busy, or doesn’t even know the answers to your questions, that can be an answer right there. You deserve to have a provider who takes the time to answer questions and concerns, and who sees the value in a mother being informed and “picky” about her provider.
Choosing a provider is not the time to be soft and passive. Many women find themselves afraid to ask questions or express their preferences for fear of annoying their provider. Others may know in their heart they want to switch, but don’t want to make waves or risk offending anyone. Many women may begin to see red flags as their pregnancy progresses, but think it is “too late” to switch, or they have idealistic hopes that, somehow, they will be the exception. It is important for your health and the health of your baby, as well as your growth in confidence as a mother, that you view yourself as the authority. You are the one making decisions, and it is important for you to find strength and confidence in that. Your provider is offering a service for you, not the other way around.
I’m thankful we sought out all the information we could. We felt confident in our relationship with our midwife and trusted her completely. We interviewed a number of midwives. The one we chose was upfront [in saying] that she prays for all of her clients and even included an outline of sorts of what we could pray for each week as the baby developed. I loved the extra care I received from the midwife, compared with the medical doctor I had with my first [child]. We talked about stress, diet, exercise, and other aspects of pregnancy. I wasn’t a number; I was a pregnant mom in her care whom she knew and was praying for.
— Cherie L., mom to four on Earth, one in eternity
A good provider will offer choices rather than telling you what will be done to you. A good provider will have an open conversation about options and will want you to have a birth that respects your role as the mother of your baby. While they may have recommendations and protocol, they will make sure that you are informed and have as much a say as possible in everything that happens. They will make sure you know the benefits and risks of each choice, encourage you to do your own research, and respect your intelligence and free will to make your own choice.
When choosing a provider, it’s critically important to note whether the provider is part of a group practice. If a provider is part of a group practice, it’s very important to know if every member of the group views birth and practices the same way. As part of a group practice, the provider you’ve chosen may not actually be the one who attends your birth! Even within the same practice, different doctors or midwives may have different protocols and opinions. You may agree with your primary provider, but the person who shows up on call at your birth may view things differently.
You, mom, have the right and obligation to pick a provider who is truly going to serve you and your baby well, with dignified and evidence-based care, and who will be there when it is time to birth. This person will be with you during one of the most important, emotional, and vulnerable moments of your life. Birth is messy, naked, and requires a tremendous amount of trust and vulnerability between you and the people in the room. Choosing a provider with whom you can be all of these things is not only important for your emotional satisfaction and care, but, as we’ve seen, can also play a huge role in the actual birth itself. A provider who offers you an atmosphere of safety and comfort, without shame or embarrassment, is profoundly important.
Picking the top name on your insurance company’s provider list is not the best way to find a provider. Nor is doing a Google search for providers in your area. One of the best ways to begin your search is by word of mouth. Find other women who have been happy not just with the providers’ demeanor but with their own actual births, and ask them for advice. If you have friends who haven’t been happy with their care, take note of who not to use. Ask local doulas for recommendations. If you are on Facebook, find a local moms’ or birth group and inquire there (but be sure to state what kind of provider and birth you hope to have). When you make appointments to meet with a doctor or midwife, do so with the understanding, even if only in your head, that this is an interview and you are not committed to using him or her. Your first commitment is to your baby and your care, not to a receptionist or to a provider. Find your voice with the nurses and doctors and let them know you are trying to find the provider who fits you best. Do not be afraid to ask questions. Consider bringing a notebook with you to jot down responses.
Below is a list of questions that may help you decide if a provider is right for you, offering you insight into a provider’s practices:
• Where do you attend births (what hospitals, birthing center, home)?
• How long do my prenatal appointments last? How long will I see you?
• Do you work with other providers? Who will be at my birth?
• How many/what percentage of your clients end up with a natural/medicated birth?
• Do you provide care for the baby after birth, or is that transferred to someone else?
• What is your cesarean rate?
• What birth classes do you recommend or provide?
• How do you feel about a doula attending the birth?
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