Models of Maternity Care Practice
The model of care provided to the mother and baby is important no matter where the birth takes place or who is attending. The two main models of care that are typically discussed with respect to maternity care are the midwifery model and the medical/obstetric model. A woman and family's preferences and beliefs, health needs and circumstances, and her provider and setting's protocols and philosophy, will influence which model of care she chooses or receives. Knowing about the different models of care can be useful in exploring one's birth options.
These models are simply philosophical points anyone can decide to follow. As such, any or all of the features can be followed by any birth attendant at any birth setting. To determine the model of care used by your provider and setting, you can ask them questions. Childbirth Connection has great lists of questions to ask a care provider (see links below). The answers to these questions can help you understand your provider or setting's model of care.
Doctor or Midwife?
The choice of attendant for your birth is very important to the entire experience and to the outcomes for mother and baby. These descriptions are very general in nature, and it is important to remember that there are a wide range of philosophies, preferences, and capabilities that can only be learned by discussions with the individual providers and researching specific locations.
Physicians attend about 90% of all births in the U.S. There are generally two specialties that attend births: obstetrician-gynecologists (OB/GYNs) and family practice physicians.
OB/GYNs are surgeons that have special training and knowledge about pregnancy and birth complications. This training and knowledge makes them more proficient at handling the severe complications and emergencies that occur in a small portion of births.
Family practice physicians provide a more whole-person view of their patient, and can serve the whole family, but many of them have stopped delivering babies as a result of the extremely high cost of malpractice insurance.
Physicians generally attend births only in hospitals and typically form large group practices.
Asking questions like these may help you find a physician who is a good match for you and your family.
Midwives attend about 10% of all births in the U.S. Typically, there are three general categories of midwives: certified nurse midwives (CNM), certified professional midwives (CPM), and lay midwives (LM).
CNMs are highly trained in nursing and then midwifery. They meet the requirements of the American College of Nurse Midwives (ACNM). They can be licensed and practice in every state in the United States.
CPMs are highly trained in midwifery. They meet the standards for certification set by the North American Registry of Midwives (NARM). The CPM is the only international credential that requires knowledge about and experience in out-of-hospital settings. As of August, 2014, 26 states regulated CPMs, including RI.
The term "Lay Midwife" has been used to designate an uncertified or unlicensed midwife who was educated through informal routes such as self-study or apprenticeship rather than through a formal program. This term does not necessarily mean a low level of education, just that the midwife either chose not to become certified or licensed, or there was no certification available for her type of education.
Midwives attend births in hospitals, birth centers, and at homes. CNMs attend births in hospitals, birth centers, and homes. CPMs and LMs typically only attend births in homes, Usually, midwives form small, or solo, practices and most work with and refer clients to OB/GYNs and other medical specialists for support in the rare births that present severe complications or other medical needs. Depending upon the state licensing status of the midwife, they may be able to order sonograms, blood tests, screenings, or other pregnancy related testing.
Asking questions like these may help you find a midwife who is a good match for you and your family.