Midwifery vs. Medical Model of Care

In this post we are featuring an assignment from one of our most-recently certified doulas, Holly from Louisiana. This particular assignment (assignment 1.1 from unit 1 in the main course) addresses the difference between the two predominant models of  care with regards to childbirth: midwifery and medical.  Holly chose to respond to this assignment with her own personal experiences from her own first two contrasting childbirth experiences.

In this assignment, I was asked to compare two stories and to evaluate whether they fall under the midwifery model or the medical model. I would actually like to write about my own personal births. They were both very different.

The First Birth

With my first son, I felt as if my doctor was steered more towards the medical model. I felt as if she was always looking for something wrong. Constant tests, needle picks, etc. At 30 weeks, I was having Braxton hicks contractions (which I now know can be a normal part of pregnancy). [The doctor] declared that I had cervical funneling and ordered strict bed rest, to insert vaginal progesterone daily, [non-stress tests] tests twice a week, and I also had to have the test where they swab your cervix to see if labor is coming soon twice a week.

36 weeks came along and I was finally able to walk around again and finish my progesterone. I talked to [the doctor] about encapsulating my placenta and natural birth. I also asked what herbs are best post partal for a woman with PCOS (polycystic ovarian syndrome). I felt as if she was offended by my want for a natural approach.

She actually never answered my questions and left me in the room to finish my appointment with my nurse practitioner, and she also pushed the drug Citotec. I did my research and Citotec can cause an amniotic embolism and isn’t even intended for a pregnant or nursing mothers. I also declined the circumcision that they pushed on me. They looked down on me for all of my decisions and continued to push me on the medial aspect of things for the next 3 weeks until delivery.

I fell into labor on my own at 39 weeks. When I got to the hospital I was 5 cm dilated and completely effaced. They began Pitocin because that’s what the doctor ordered. I was so confused [that] I stated that I must have been mistaken for someone else. I was not being induced. I didn’t need Pitocin. I was then informed that its standard protocol for this doctor to augment all of her labors with Pitocin. I was not allowed to stand up or walk to help my labor. I was confined to a bed with a bed pan.

[The doctor] came in an hour later and ruptured my membranes. I asked why we had to do that? I then stated that I wanted my membranes to rupture when my body was ready for them to rupture. She [said] that it was to help the labor along and for me to progress faster. I [replied] that I thought that’s what the Pitocin was for. She had no answers and left the room leaving me full of questions.

I annoyed all of my nurses because I had a million questions. I was scared and continuously turned down the epidural. After the doctor and nurses [continued] pushing the epidural on me, I finally caved in and got it at 8 cm. 2 hours later I pushed out a healthy 7 lb 13 oz baby boy. I immediately stated that I wanted delayed chord clamping (something that I already spoke to her about but wanted to remind her) and that I wanted immediate skin to skin to promote breast feeding.

[The doctor] cut the chord. The nurses took my baby on the other side of the room to clean him, check his weight, and his stats. He scored a 9 on the birth scale. I felt cheated. My baby screamed immediately and was healthy. Why did they have to take him from me? As I was getting stitched up I watched them with my baby. This doctor followed no midwifery practices. This whole story in my opinion is an example of the medical model.

The Second Birth

With my second son, everything was completely different. I switched doctors, and I switched hospitals. [There was] no bed rest; no constant monitoring. I was assured that my Braxton hicks was completely normal. The doctor was pro- non-circumcision and believed there was no reason to preform a cosmetic procedure on a baby. He also printed up consent forms for me to take my placenta home. [He] told me how proud he was of me for taking charge and doing my research.

I fell into labor at 37 weeks even. I labored naturally without any Pitocin and was able to walk around my room and use the bathroom. Unfortunately, there was no birthing tub, but compared to my previous experience, this was a blessing. I labored drug free to 7 cm.

They actually gave me the option for Pitocin because my contractions weren’t as consistent as they would like to see them. I elected for it, and I felt better because it was my decision. I then asked for the epidural on my own because I remember the last time how much more the Pitocin made my labor hurt. My bag of waters ruptured on their own, and they called my doctor to come in because I had a little meconium in my waters. He said that the amount didn’t worry him and that there was no need to page the NICU (neonatal intensive care unit). I labored for 3 more hours.

At 1:40, I pushed out a healthy 7lb., 8oz. baby boy, who was immediately placed on my chest as soon as the chord was cut. My baby was covered in blood and vernix. It was so natural and raw and everywhere. I breastfed immediately. It was the most beautiful experience of my life. This doctor is a solid example of a midwifery model.