The following excerpts from Chapter 13 “Ina May’s Guide to Childbirth” By Ina May Gaskin

“One of the greatest influences on what happens to you during labor (especially as this relates to medical interventions, procedures, and medications) depends upon whom you choose to be your caregiver. In North America there are three separate professions that provide maternity care: midwives, family doctors, and obstetricans.”

Midwives are specialists in normal pregnancy and birth. Midwifery care is individualized and focuses on minimizing the use of obstetrical intervention when possible. In the United States, there are three basic catagories of midwives. Certified Nurse-Midwives (CNM’s) are registered nurses and have completed additional postgraduate training at an institution accredited by the American College of Nurse-Midwives (ACNM). Direct-entry midwives are those who did not become registered nurses as a step toward midwifery training. There are two varieties of certified direct-entry midwives in the United States: Certified Professional Midwives (CPM’s) (who are certified by the North American Registry of Midwives) and Certified Midwives, who are certified by the ACC, the credentialing arm of the American College of Nurse-Midwives.”

“About thirty percent of family doctors practicing in the United States provide maternity care. Several studies have found that family doctors tend to have lower rates of obstetrical intervention than obstetricians.”

Obstetricians are doctors  who have specialized in obstetrics. Their medical training is focused on detecting and treating the pathological problems of pregnancy, sometimes labor and birth. When obstetricians provide maternity care for healthy women, they often apply interventions that are appropriate for complicated pregnancies to all women.”

A wonderful video on choosing a care provider…


Midwives Model of Care Medical Model of Care
Definition: Definition:
• Birth is a social event, a normal part of a woman’s life. • Birth is the work of the woman and her family. • The woman is a person experiencing a life-transforming event. • Childbirth is a potentially pathological process. • Birth is the work of doctors, nurses, midwives and other experts. • The woman is a patient.
Definition: Definition:
• Home or other familiar surroundings. • Informal system of care. • Hospital, unfamiliar territory to the woman • Bueaucratic, hierarchical system of care
Definition: Definition:
• See birth as a holistic process • Shared decision-making between caregivers and birthing woman • No class distinction between birthing women and caregivers • Equal relationship • Information shared with an attitude of personal caring. • Longer, more in-depth prenatal visits • Often strong emotional support • Familiar language and imagery used • Awareness of spiritual significance of birth • Believes in integrity of birth, uses technology if appropriate and proven • Trained to focus on the medical aspects of birth • “Professional” care that is authoritarian • Often a class distinction between obstetrician and patients • Dominant-subordinate relationship • Information about health, disease and degree of risk not shared with the patient adequately. • Brief, depersonalized care • Little emotional support • Use of medical language • Spiritual aspects of birth are ignored or treated as embarrassing • Values technology, often without proof that it improves birth outcome


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