In simple words, the Medical Model of Care is disease/illness based. It tends to view pregnancy and childbirth as a problem that must be managed through monitoring and intervention. In other words, your body can't be trusted to do it well and right and interventions are required.
The Midwifery Model of Care, in contrast, views pregnancy and childbirth as a normal process - something your body was designed to do and a one that only requires management/intervention when complications arise. It is centered on mutual trust between caregiver and client to provide complete and holistic care throughout pregnancy, birth and the postpartum period. Your body can be trusted, your body is designed to do this and, more times than not, medical intervention is not required. You are the most active participant in this journey and much of care is focused on educating, preparing and empowering you to navigate the many decisions involved in pregnancy and child birth. Midwives focus on monitoring for normal and screening throughout care to ensure everything is progressing normally and then to identify and address any issues that arise and may indicate the need for consultation with or transfer to providers within the medical model of care.
When I worked as a Labor and Delivery nurse I encountered the Medical Model of Care every shift I worked and saw it's impact in every birth I was a part of. I saw the place for this model of care in managing high risk pregnancies and complications like premature birth, uncontrolled gestational diabetes and preeclampsia. I saw the miracles accomplished through it and good outcomes where once not so very long ago there would have only been loss. But I also began to see, time and time again, low risk patients and families come in with a plan or hope of how their birth would look only to them watch them encounter, often with devastating effects, the ridged protocols and policies of the medical system; protocols and policies that often didn't seem to exist for the patient's benefit but rather the hospitals or providers.
Over and over I watched patients have to fight against the medical system and hospital protocols to try to hang on to the birth experience they wanted and hoped they'd have. I witnessed the vicious cycle of patients getting trapped in a landslide of one intervention leading to another and then another while the risks and possible complications associated with their labor and birth increased each time.
"This is not what birth is ment to be like!" my heart told me and it mourned with each family who fought against the medical system and walked away with a healthy baby in their arms but feeling as though something had been taken from them in the process. I strongly believe that no family should have to fight to have the type of care and birth experience they want and that midwifery care and home birth offer something truly unique and difficult to find/experience in the medical system.
In the medical system you give birth in hospital room with one or more nurses taking care of you, restrictions put on you as to how many others may be present from friends and family, and you may or may not have the provider who did your prenatal care present to care for you during your birth. Often provider practices are group practices meaning there is a good chance your delivering physician is not going to be the provider you'd seen for your prenatal care.
Choosing a home birth gives you the opportunity to labor and give birth in YOUR space surrounded by those you love and choose to be there with you. I can't emphasize enough how impactful it is to labor and birth in your own home where you feel comfortable and safe. Choosing a home birth midwife allows you to find one that fits you and your family's needs best; one you can trust and want to come alongside you as you navigate prenatal care, birth and your postpartum period. Chosing a home birth allows you to choose a midwife who will be present with you all throughout the entirety of your prenatal care, labor, birth, and postpartum care!
For those who have beliefs and thinking that align more with the Midwifery Model of Care than the Medical Model of Care and who have a low risk uncomplicated pregnancy - home birth with a knowledgeable and skills midwife can be a beautiful, empowering, and life changing experience! In my years of working as a midwife I've seen this time and time again which is what makes me so passionate about what I do. So many faces of women flash through my mind as I write this - faces just absolutely beaming right after their baby is born as they tell me, "I did it!" Birth can be incredibly empowering, affirming, and a true discovery of the strength you didn't know you had. Your body was designed to do this.
In my years of working as a midwife I've also talked with families and women who have a lot of anxiety about their pregnancy and birth process or who have a partner who does. Now, most times, sitting down and having a consultation with a family has alleviated most concerns about moving forward with a midwife and plans for a home birth. Often times fears are relieved and concerns addressed when we talk about my training, the medications and oxygen I carry, how equipped I am to monitor for and address any emergencies should they arise with mom or baby, etc. Quite a few partners, in my experience, need this conversation to feel comfortable in even considering a home birth!
There are some families though who continue to be anxious and unsure about what the right decision is. I've had to remind some of them that there is no "right decision", home birth may not right for everyone, and the most important factor in making a decision is being on the same page as their partner and in a place where are going to feel the most comfortable. For some, that is within the medical system and thats ok!
If you are having a normal healthy pregnancy and are considering a home birth, even just a little bit, I encourage you simply reach out and talk to some different midwives. Having conversations with a midwife about what home care and home birth look like for you, and asking all the questions you are wondering, is the first step toward helping you make the best decision for you and your family.
When I mention I'm a midwife it has not been uncommon to hear people think the term outdated and to not really know what a midwife is! When we talk about what a midwife is, it is important to know there are different types of midwives and to be able to distinguish between them and discern which is the best fit for you.
CNM (Certified Nurse Midwife) or CM (Certified Midwife)- these midwives have a Master's degree in Midwifery. In the case of CNMs they also have Bachelor's degree in nursing whereas a CM has a Bachelors degree in something other than nursing. Both CNMs and CMs are largely hospital based and often have have to comply with medical protocols in how they approach and manage any issues or complications that arise. Most work in hospital alongside doctors, have prescriptive authority, and will transfer any complications outside of their scope of practice to the physicians in the group. A select few do work in the home birth setting and are typically very wonderful and knowledgeable in my experience!
CPM (Certified Professional Midwife) - there are two main routes to becoming a CPM and obtaining accreditation as a CPM through NARM (North American Registry of Midwifes) The first is through a MEAC accredited midwifery school and involves a combination of class or course work as well as work under the supervision of a qualified preceptor(s) to obtain the required amount of hands on experience to complete the program. Generally through this route the midwife obtains an Associates or Bachelors degree. The second is through a self study or a non accredited program, an apprenticeship with a qualified midwife to become signed off on their experience and skills and then through completing of an Entry-Level Portfolio Evaluation Process with NARM.
My point in all of this, is you won't necessarily know the training and background of a midwife unless you ask them. Just as we've all probably been to good dentists and not so good dentists, or good mechanics and not so good mechanics etc. the same can be true of midwives and providers in any profession. My encouragement is always to ask questions, interview multiple midwives, determine what educational background they've had, what experience they've had, and whether or not they are the best fit for you and someone you can fully trust to navigate your pregnancy and birth alongside you.