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INTRODUCTION

When my midwife entered the room during our first visit, she was not at all what I had been expecting. I think I imagined a friendly granny or a long haired hippy in a skirt down to her ankles. Instead, Lisa entered the room with her short, spiky red hair, wearing thick purple glasses and blue jeans. She warmly greeted me, immediately setting me at ease, and spent the better part of the next hour reviewing my health history, discussing my usual diet and exercise and making suggestions for improvement, and exploring how I was planning to deliver this baby, my second child, and integrate him into our family. We talked about what had gone right in my last pregnancy and delivery and what I hoped would be different this time around. I was struck by how different this type of care felt from that I received previously with my obstetrician. In my initial visit with my OB, we had reviewed my bloodwork, discussed testing options, and I left with a list of do’s and don’ts and when to call. My midwife did those things too, but they were not the focus. I felt like the focus was much more on me as a person this time around. The visits that followed, while less time consuming, were still more personal and by the time my labor started, I felt like Lisa really understood me. She was calm and reassuring during the labor, which this time I had decided to do without any medication. She really let me know that I could do it and I had a smooth, easy all natural delivery. I don’t know if it was that way because it was my second time or because of Lisa, but I would choose a midwife again if I had a third child. The entire experience was better all around.

—L. A., new mother

THE MIDWIFERY MODEL OF CARE

With the increasing awareness of the problems afflicting the American maternity system, many have begun to question whether, at this point, we are too far gone along the path of intervention as standard of care to ever change course. It seems particularly unlikely that change is possible when we continue to apply the same philosophy of care, birth in the same locations, and utilize the same providers. How many generations of doctors will it take before the main tide of opinion favors low intervention and natural options for childbirth. This is because, as profoundly stated by Akileswaran and Hutchinson,1 “what is missing is a reference point of what is normal; the concept of normalcy is secondary in the medical model of health, in which suspicion of pathology is often the lense for each interaction or decision.”

The midwifery model of care offers that reference point, by beginning with view that pregnancy and childbirth are normal life events. This does not mean midwives ...

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