In our modern society, pregnancy is a time full of overwhelming choices!  Perhaps the most important decision you will make is choosing your prenatal care provider.  Finding the right provider for you can mean the difference between having a positive birth experience and not.


What is your philosophy of birth? Pregnancy and birth will be much smoother if your care provider shares your basic birth philosophy.  While every person will be slightly different, there are two basic “camps” or “models of care”.




Medical Model of Care


The medical model of care is where most OBs will fit.  OBs are highly trained surgeons who are very skilled at treating life-threatening conditions and complications.  The medical model of care focuses on routine testing to detect possible complications, and routine procedures designed to facilitate labor and birth.  This philosophy is about making the most advanced medical techniques available to every pregnant woman.


This model of care generally believes that the doctors and nurses know best, and is sometimes unsupportive of mothers who make nonstandard choices. It is an excellent model for mothers with high-risk pregnancies who need medical support.  Unnecessary interventions in low-risk women may, however, cause complications in birth.


No two Obstetricians are alike. Be sure to interview a few to find the right one for you!




Midwifery Model of Care


The midwifery model of care is where most homebirth midwives will fit. Midwives are trained in natural, low-risk birth. Midwives know how to spot complications, and seek expert medical care only when necessary. This birth philosophy is about believing that birth is safe for most mothers and babies, that birth is a physiological process, not a medical condition.  The midwifery model of care focuses on nurturing the mother with excellent nutrition and emotional support to keep her pregnancy low-risk.  Often prenatal tests are available to mothers through midwives or referral, but not mandatory.  


This model of care generally believes that the mother is the expert in her own birth, and may seem inadequate to mothers who identify more with the medical philosophy.  The midwifery model of care is not appropriate for high-risk mothers, and when starting care with a midwife, you may be transferred to an OB later if complications arise.


No two midwives are alike. Be sure to interview a few to find the right one for you!


The lines are not always clearly drawn.  Some Obstetricians practice a midwifery model of care and intervene only when necessary.  Some midwives are liberal in applying interventions. Hospital midwives often employ a combination of the two care models.  It is very important to interview before choosing your provider.




How is Your Health?


This is important. If you are high-risk, you probably need an OB, even if you would prefer a midwife.  (In this case a doula could be invaluable!)


If you are low-risk, an overly eager OB may actually cause labor complications with unnecessary interventions.




What Environment Would You Like to Give Birth in?


rsz_1rsz_birth_partner_001Hospital?  Home?  Birth Center? The safest place to give birth is the place you feel the safest.


 If you want a home birth, that rules out an OB in most parts of the world.  If you feel safer in a hospital, you might not have the option of a midwife. (some hospitals do, some don’t) Birth Centers almost always have midwives.




What is your plan for pain management?


In the US, there is very little medical pain relief available for a home birth.   In other countries, midwives may be allowed to bring gas & air, or mild pain relievers. While midwives aren’t allowed to carry these things here, there are LOTS of natural pain relieving options.


In a hospital under an OB, you have access to all the medical methods of pain control, full epidurals, partial epidurals, narcotics etc.  However, many hospitals have policies that restrict what natural pain coping techniques you are allowed to use.






Unless you live in a country with nationalized health care, this can be THE deciding factor for many families.  Although home birth is far less expensive that a hospital birth, many US insurance companies refuse coverage.  This means many families have to pay out-of-pocket for a home birth.


This is a gap that freestanding birth centers can fill!  With my first pregnancy, although I wanted a home birth, we couldn’t afford it.  I settled for a midwife-run birth center that our insurance would pay for.  It was a beautiful, holistic, home-like experience.


A side note on affording a home birth:  We and many families we know use Samaritan Ministries instead of traditional insurance.  They are a Christian health-share group. They cover maternity (including home birth), emergencies and other health issues, but will not cover pre-existing conditions, contraceptives or routine preventative care.




Changing Care  Providers


Just because you start working with one provider, doesn’t mean you have to stay with them.  If something doesn’t feel right about them, if you find yourself being pushed into choices you aren’t comfortable with, if you find yourself feeling uncomfortable or unsafe around them, then please, transfer to another provider!


Whatever model of care you choose, whether you choose an OB or midwife, feeling completely comfortable and trusting in your provider is essential to being able to let go during labor.  Don’t make things harder or set yourself up for problems.  Make sure you have a provider you enjoy working with.




In Corde Maria,


Jessica Ghigliotti


Immaculate Heart of Mary




featured image via flickr user Sean McGrath

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