 Midwifery Model of Care
"I sometimes wonder why [we bother compiling statistics on midwives], since their statistics are so much better than everyone else's." - Rebecca Watson, New Mexico Department of Health
Planned home birth, likewise, has been proven safe for healthy women with normal pregnancies. Modern midwifery care is based on the following concepts:
- Pregnancy is a normal, low risk, significant time in a woman's life.
- Pregnancy is a part of a woman's cycle of life.
- Pregnancy affects and is affected by all of a woman's life: social, economic,
professional, familial.
- Women have the right to choose a care provider and with whom and where to give birth.
- A woman knows her body and her needs and wants.
- A woman can educate herself about care options and make the appropriate
choices based on impartial and complete information.
A midwife spends time with her clients - getting to know them, teaching them and helping them think through their options to make reasoned decisions. The midwife spends some time with the client's partner present, observing the dynamics and providing holistic support. The midwife visits the home to help identify how best to prepare the space for labor and birth. A typical prenatal visit lasts 30-60 minutes, labor accompaniment is consistent through the active part of labor and birth, and postnatal care includes several follow-up visits. One estimate is that midwives spend 5-15 times as many hours with their clients as doctors spend - at about half the price! Midwifery care makes sense for normal pregnancies because midwives are skilled at keeping the pregnancy normal. If something does shift out of normal, the midwives will consult with specialists and make referrals when needed.
Midwives can take several paths to prepare them for this work. Some choose to enter midwifery via nursing. Many of these are labor and delivery nurses who realize their calling is to midwifery, and go back to school, which is typically three years of study at a university. Others want more of a medical background or want to work exclusively in a shospital setting. These midwives, after sitting for an exam, are identified as a Certified Nurse-Midwives.
Some midwives prefer to enter the field directly. These women place a strong emphasis on the fact that pregnancy is not a medical condition, but a safe, normal, physiological event in the lives of most women. Direct-entry midwives (DEM) have several options for their preparation. Some follow an apprenticeship model while others follow a more academic model. Both paths include academics and apprenticeship, but the emphasis is different. Most midwifery training programs require between three and six years of study and experience. Some DEMs choose to sit for an exam and are then identified as Certified Professional Midwives (CPM).
Do not be confused by the 'alphabet soup' of the titles and initials - the skill knowledge and attitudes of the midwife parents choose is the importance.
Citizens for Midwifery, Midwives Alliance of North America and the American College of Nurse-Midwives provide more information about Certified Professional Midwives and Certified Nurse-Midwives.
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