Medical model of care vs. Midwifery model of care

September 22nd, 2010 § 0 comments § permalink

I wrote this as a new midwifery student as part of my homework. Since I am studying for the NARM, I am going through all my homework to refresh my memory, and remind myself of things I have forgotten, and pick up on things I missed the first time through.

Explain the difference in the medical model of care and the midwifery model of care.
The midwifery model of care encourages women to trust in God’s elegant design of their bodies, and His design inherent in childbearing; it recognizes that conception, pregnancy, and birth are natural processes that God designed to function with minimal intervention. The female body is seen as unique, and normal. Midwives realize the value in good nutrition, exercise, and a wholesome lifestyle and supportive, healthy family relationships to promote good health and minimize complications. The midwifery model of care recognizes the mother as the only direct health-care provider for her unborn baby. When the mother is taking good care of herself, the baby will also be well-cared for. The midwifery model of care believes it is the client’s responsibility to make their own choices about tests and treatments, so midwives respect their clients by providing them with complete and accurate information for them to make informed health care decisions for themselves and their babies. Midwives seek to avoid practices and treatments based solely on fear, and instead seek to only carry out only those that have clear benefits for the mother and her baby. The process of pregnancy and birth is important to midwives, as well as the outcome. Midwives recognize that unnecessary interference can cause complications that would not otherwise occur, therefore they see themselves as guardians over these natural events and seasons, and intervene only as necessary for the health and well-being of the mother and baby. “One size fits all” does not apply to labor and birth; the midwife recognizes that each pregnancy, labor, and birth will be unique, and she is prepared and willing to be patient and flexible, allowing each woman’s body the time it needs to bring forth the baby, and in whatever positions are most effective. They also realize that spiritual and emotional issues can slow or stall labor, and they seek to resolve these, if at all possible. Midwives see pain in childbirth as a positive force because it brings forth a baby; they recognize that it is not a damaging pain, and therefore, it should not be feared. The midwifery model of care contends that mothers can birth just as safely, and more so, at a home or birth center, than in a hospital. The midwifery model of care sees birth as a personal, spiritual, and social event. Although in today’s world midwifery is viewed as “alternative” or “non-traditional”, until recent history, midwifery has been the traditional care—often the only care—for women worldwide.
The medical model of care sees pregnancy, labor, and birth as events that are fraught with dangers, and inherently pathological. They view the male body as the norm, and the female body as deviating from that. More often than not, the medical model offers fear-based care: in other words, they will intervene in the natural process to prevent certain complications, often causing other problems as they do so. The expectation, detection, and management of problems is foundational in the medical model of care. The expectation is that all births will need intervention. Mainstream medicine has a rather mechanical view of the body and treats symptoms rather than seeking to identify and treat the cause. They consult time charts to determine how long labor may take; they view deviations from these schedules as unsafe. If labor is slow or halting, Pitocin is used. The medical model of care values only the scientific—only that is can be measured or tested is viewed as useful information; the objective is valued, the subjective is mistrusted. In the medical model, the doctor is in charge and responsible for the outcome—as it is he who is making nearly all the decisions. The ultimate goal in mainstream medicine is to avoid death at all costs.

Resource: Holistic Midwifery by Anne Frye

"Before Moses Delivered Israel…

June 13th, 2010 § 0 comments § permalink

Shiphra and Puah delivered Moses.” (Yes, I realize that it was God who delivered Israel from their bondage in Egypt—not Moses, who was just the instrument God chose to use. Likewise, Christian midwives recognize that it is truly God who brings forth babies from their mothers’ wombs—we are just the instruments He uses sometimes!)

So says my t-shirt, given to me by a midwife friend. I’ve received many comments on it when I wear it. I have come to realize that most people, however, even Christians, don’t know about Shiphra and Puah—unless they are midwives themselves—so I decided to do a post on them and midwifery in ancient Egypt.

Although its not certain that Shiphra and Puah actually delivered Moses, they were recognized as “the Hebrew midwives” or “midwives to the Hebrews”. Historical sources are not clear on whether they were Hebrews themselves, or whether they were Egyptian midwives assigned to deliver the Hebrews babies. Either way, the Hebrew Scriptures, and Josephus, a Jewish historian, speak highly of them. Below is an excerpt from a paper I wrote on the history of midwifery, entitled “Created to Give Birth”.

Midwifery in Ancient Egypt
In Hebrew, or biblical culture, children were considered one of the greatest blessings, and an inability to conceive and have children was viewed as a curse. Indeed, “fruitfulness” was a command from Yahweh, the Lord, to the people of God: “Be fruitful, and multiply, and fill the earth and subdue it.”10 (Emphasis mine.) A similar attitude toward children is also seen in the ancient Egyptian culture. A large family was an honor to parents, and especially to the father, the head of the household. Even though the Egyptians were prolific, and childless couples were expected to adopt to make up for their lack, they were not as fruitful as the Hebrews. At this time, the Hebrews were enslaved to the  Egyptians, and the Pharoah was afraid they would rise up against his kingdom, along with an enemy nation, and overthrow him because of their great number. To limit their numbers, Pharaoh ordered Puah and Shiphrah to kill any boy babies when they attended the women in travail and saw them on the birth stools or “stones”. Josephus, Jewish historian, records that Pharaoh’s order was to Egyptian midwives, because Pharaoh would not presume that Hebrew midwives would obey his order. Risking the wrath of Pharaoh, Puah and Shiphrah spared the Hebrew boys because they feared God. When called to account for their disregard of the Pharaoh’s command, Puah and Shiprah said that, unlike the Egyptian women, the Hebrew women birthed quickly, before the midwives could arrive. Because the midwives feared God, He dealt well with them and blessed them with families. These midwives not having families of their own challenges the common assumption that all midwives in ancient times were older women with children of their own, or even beyond childbearing age. Pharaoh’s mention of the “stool” or “stones” is important, because it gives us knowledge about the birth position commonly used by the Hebrews. In her book, Birth Chairs, Midwives and Medicine, Amanda Carson Banks explains, “The first external, material objects used [as birth chairs] were birth stones and stools. Birth stones were two pieces of roughly shaped rock placed slightly apart so as to create a makeshift seat or stool with an opening in the middle on which the mother sat or kneeled.” The birth stool was also an accepted birth position for Egyptian women. The Egyptian hieroglyphic for birth is a depiction of a woman giving birth seated on two stones, or a low birth stool. According to Dr. Wegner, an archeologist from the University of Pennsylvania, Egyptologists have long known that the standard form of childbirth in ancient Egypt was for the woman to give birth squatting on two mud bricks. Squatting has the double benefit of opening the pelvis, and using the force of gravity to bring the baby down. Egyptian women were commonly attended by two midwives—one attending to the mother, and the other to the newborn baby, in accordance with Egyptian religious beliefs.