We subscribe to a bunch of kids’ magazines around here. A couple of kids’ literary magazines, a couple of science magazines, a history magazine. This and that. A regular influx of new ideas to read and ponder = good, I think.

One of the kids’ science magazines just arrived. This month’s theme: Growing Up. Much of the focus was on animals—hatching eggs, metamorphosis, how puppies are born. But one story was about—go on, guess—human gestation. Pregnancy.

The story is set up as though the narrator is speaking to the child-reader. When you were in your mommy’s tummy, this happened! And then this! Like that.

So I read it with the kids, which led to them asking all sorts of good questions:

Why does it say the mom will see a doctor? Why doesn’t it say “doctor or midwife?”

Why does it say the baby was born in a hospital? Why doesn’t it say “might have been born in a hospital?” Or “some babies aren’t born in hospitals?”

Why is the mom lying down when her baby is born?

Dear magazine-makers: when my nine- and six-year-olds can create a more accurate and inclusive description of birth than your educational content providers did, you may have a problem.

And then the kids and I got to discuss, just a little and at an age-appropriate level, why some women choose midwives and some choose doctors.

People often think we use a midwife because she’s friendlier than a doctor, or because we like her more. Um… no. We are friendly with our midwife. We live in the same neighborhood. Our kids have been to each other’s birthday parties. Our personalities mesh well. But I first hired her because she’s an excellent midwife. And I preferred to be attended by a midwife rather than a doctor both because I wanted to give birth in a particular location (home), and because I wanted a health care practitioner that followed the midwifery model of care (as opposed to the medical model of care).

The midwifery model of care, though, doesn’t mean “care provided by a midwife,” just as the medical model doesn’t mean “care provided by a medical doctor.” Each model describes a different philosophy of care, and involves different practices and norms; each is associated with different outcomes. There are valid and logical reasons for choosing each of these models, and both have a rightful place in our health care system.

The midwifery model focuses on health, wellness, and prevention, while the medical model focuses on managing problems and complications. (The midwifery model also pays special attention to identifying and referring those women who need obstetrical intervention.) Care is individualized in the midwifery model, and made routine in the medical model. The midwifery model is associated with lower rates of intervention, and with higher maternal satisfaction. It also fits with and honors my personal belief that—under normal circumstances—my body was made to be able to give birth.

There are doctors who follow the midwifery model, and some midwives who more closely follow the medical model. (Some have argued that the models should be called the physiological model and the pathological model, to better describe them, but those names haven’t really caught on. Go figure.) Asking a few pertinent questions can usually help a woman determine what model of care a birth attendant embraces.

Not everybody believes what I believe; not everybody wants the same things I want in a birth attendant. But there are real and measurable differences between these two models of care, and we should each be able to choose a birth attendant whose philosophy best suits our circumstances and our values. Which philosophy fits us best is something we can each decide for ourselves. Of course.

For more information on these models of care:
The Midwifery Task Force’s brief definition of the midwifery model of care is available here. An expanded explanation can be read here.

Our Bodies, Ourselves offers definitions of both the midwifery model of care and the medical model of care. Childbirth Connection also compares the two models.