Birth in the United States What your mother didn’t teach you about pregnancy and childbirth

Birth from two perspectives Comparing Models of Childbirth

What is Health?  Psychological  Sociological  Physical

Paradigms of Birth  Biomedical Paradigm  Birth as illness  Technocratic Paradigm  Focus on technology  Holistic Paradigm  Birth as natural process

Midwifery

Midwifery Model of Care Overall theme: Pregnancy and birth are normal life events.  The tenets of the model include:  Monitoring the physical, psychological and social well being of the mother throughout the childbearing cycle  Providing individualized education, counseling and prenatal care, continuous hands on assistance during labor and birth and post partum support  Minimizing technological interventions  Identifying and referring women who require specialized obstetrical services

Midwifery Model of Care  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.  Longer, more in-depth prenatal visits  Information shared with an attitude of personal caring  Familiar language and imagery used

Midwifery Model of Care  Shared decision-making between caregivers and birthing woman  No class distinction between birthing women and caregivers  Awareness of spiritual significance of birth

Medical Model of Care  Pregnancy is viewed as a potentially threatening condition requiring close surveillance and monitoring  The role of technology is highly valued in the process of monitoring the status of women during the childbearing year  The goal is a healthy mother and healthy newborn as the outcome of the labor and delivery process.

Medical Model of Care  Information about health, disease and degree of risk may not be shared with the patient adequately.  Brief, depersonalized care  Little emotional support  Use of medical language  Spiritual aspects of birth are often ignored

Medical Model of Care  Birth is the work of doctors, nurses, and other experts.  The woman is a patient  "Professional" care that is authoritarian  Dominant-subordinate relationship

Why is Maternity Care Like This?  Why are some medical interventions still being overused in the United States today, despite the evidence against them?  Obstetrical training and the medical system  Economic incentives and fear of the law  A rushed, risk-avoiding society

Mother-Friendly Childbirth  They have developed what they call The Mother-Friendly Childbirth Initiative

Normalcy of the Birthing Process  Birth is a normal, natural, and healthy process.  Women and babies have the inherent wisdom necessary for birth.  Babies are aware, sensitive human beings at the time of birth, and should be acknowledged and treated as such.  Birth can safely take place in hospitals, birth centers, and homes.  Breastfeeding provides the optimum nourishment for newborns and infants.  The midwifery model of care is the most appropriate for the majority of women during pregnancy and birth.

Empowerment  A woman’s confidence and ability to give birth and to care for her baby are enhanced or diminished by every person who gives her care, and by the environment in which she gives birth.  A mother and baby are interdependent during pregnancy, birth, and infancy. Their interconnectedness is vital and must be respected.  Pregnancy, birth, and the postpartum period are milestone events in the continuum of life. These experiences profoundly affect women, babies, fathers, and families, and have important and long-lasting effects on society.

Autonomy  Give birth as she wishes in an environment in which she feels nurtured and secure, and her emotional well-being, privacy, and personal preferences are respected.  Have access to the full range of options for pregnancy, birth, and nurturing her baby, and to accurate information on all available birthing sites, caregivers, and practices.  Receive accurate and up-to-date information about the benefits and risks of all procedures, drugs, and tests suggested for use during pregnancy, birth, and the postpartum period, with the rights to informed consent and informed refusal.  Receive support for making informed choices about what is best for her and her baby based on her individual values and beliefs.

Do No Harm  Interventions should not be applied routinely during pregnancy, birth, or the postpartum period.  If complications arise during pregnancy, birth, or the postpartum period, medical treatments should be evidence-based.

Responsibility  Each caregiver is responsible for the quality of care she or he provides.  Maternity care practice should be based not on the needs of the caregiver or provider, but solely on the needs of the mother and child.  Each hospital and birth center is responsible for the periodic review and evaluation, according to current scientific evidence, of the effectiveness, risks, and rates of use of its medical procedures for mothers and babies.  Individuals are ultimately responsible for making informed choices about the health care they and their babies receive.

Mother-Friendly Childbirth: EVIDENCE  The Evidence for the Ten Steps of Mother Friendly Care is the result of an extensive review of the research behind today’s maternity care practices by the Coalition for Improving Maternity Services (CIMS) Expert Work Group *The following information is adapted from an entry in the Journal of Perinatal Education, Vol. 16, Supplement 1, Winter 2007

Unrestricted Access to Birth Companions  Perception of support during labor was a key ingredient in a woman’s satisfaction with her birth experience.  More satisfaction was reported with birth support when provi ded by a partner or doula, compared to a doctor or nurse.

Access to Midwifery Care  Increased length of prenatal visits, more education and counseling during prenatal care  Less need for analgesia and anesthesia as well as more freedom of movement and intake of food and drink;  Decreased use of IVs, electronic fetal monitoring; fewer inductions of labor and fewer episiotomies; fewer cesareans overall, including fewer emergency cesareans for fetal distress or for inadequate progress in labor, and more vaginal births after cesareans (VBACs);  Fewer infants born preterm, low birthweight or with complications such as birth injury or requiring resuscitation after birth, and more infants exclusively breastfeeding at 2-4 months after birth.

Culturally Competent Care  Associated with improved communication, avoidance of medical errors, and increased patient/client satisfaction and confidence in health provider.

Freedom of Movement Walking during first stage of labor decreased the likelihood of delivery by surgery, forceps or vacuum extraction. Movement may shorten labor, were effective forms of pain relief, led to fewer nonreassuring fetal heart rate patterns, fewer perineal injuries, and less blood loss.

Continuity of Care Women who did not receive continuity of care were less likely to feel supported during labor, feel prepared for pa renthood, or discuss pregnancy and postpartum concer ns and problems with their caregiver(s).

Early Contact  Eliminating or minimizing separation of mothers and babies whenever possible reduced distress in healthy and sick infants.  Unimpeded early skin-to-skin contact increased breastfeeding initiation and duration in mothers with healthy infants.

Midwifery and Obstetrics  Midwifery and medical obstetrics are separate but complementary professions with different philosophies and overlapping but distinct purposes and bodies of knowledge.  Physicians are experts in pathology and should have primary responsibility for the care of pregnant women who have recognized diseases or serious complications.  Midwives are experts in normal pregnancy and in meeting the other needs of pregnant women— the needs that are not related to pathology. In most countries, midwives have primary responsibility for the care of women with uncomplicated pregnancies.

Midwifery and Medical Models  The midwifery and medical models are based on particular perspectives of pregnancy and birth. Both of these perspectives are valid and important; the extent to which one or the other should be given priority varies with different women.  The two approaches are complementary rather than competitive.  Most midwives acknowledge the importance of medical treatment for women with pregnancy complications, and many physicians acknowledge the importance of the social and emotional aspects of pregnancy and childbirth.

Something to Consider

Questions or Comments?

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References  American Pregnancy Association  Campbell, D. A., Lake, M. F., Falk, M., & Backstrand, J. R., (2006). A randomized trial of continuous support in labor by a lay doula. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 35(4), 456–464.  Coalition for Improving Maternity Service (CIMS)  G. Carroli and J. Belizan, Episiotomy for vaginal birth, Cochrane Database Syst Rev (1999) CD  Goer, H. (1999). The Thinking Woman’s Guide to a Better Birth. Berkeley Publishing Group.  Feminist Theory in the Study of Folklore, eds. Susan Tower Hollis, Linda Pershing, and M. Jane Young, U. of Illinois Press, pp ,  Morning Star Birth Services, LLC.