As a birthing person, finding the right provider and birth location are just two of the many decisions you will make during your pregnancy, birth, and postpartum journey. Your birth and postpartum doula can help support you in each of these choices. Understanding the philosophies of care providers and their models of care is a great starting point. A model of care is a perspective or viewpoint on pregnancy and birth that dictates the overall approach of a provider, birth location, and birth team.
Generally, there are two main models of care: The Medical Model of Care and The Physiological Model of Care. A great starting place for many people can be to consider which model of care aligns better with their personal goals and philosophy.
The Medical Model of Care
The medical model of care views pregnancy as a medical process that comes with potential health risks. Providers underneath this model of care are physicians, nurse practitioners, obstetricians, family medicine doctors, and in some rare instances– hospital-based midwives.
Beneath this model of care is the mindset that pregnancy, birth, and the postpartum period should be closely monitored, managed, and treated as problems arise. Regular medical appointments take place in a medical setting and come with traditional testing routines.
Often, your provider is not your sole point of contact during these appointments as most practices undertake care for many clients. Nurses and other staff will often begin the appointment, check in with how you are, do any scheduled tests, etc before you meet with the doctor. In some cases, it can feel disconnected as many providers work in rotations. For example, your main provider might not be the individual present at your birth.
The Physiological Model of Care
The physiological model of care differs in multiple ways. First, it views pregnancy and birth as natural physiological events that your body was built to carry out. The physiological model of care states that sometimes medical intervention is needed to aid in the natural process of labor but that healthy individuals, left to their body’s instinct, can birth their baby safely.
Another notable difference between these models of care is in how the appointments and interactions between providers and patients look. Physiological models of care are often more patient-centered and focus on a deeper connection between client and provider. Their viewpoint on labor and birth allows for more personalized care and flexibility in their approach to each client.
Midwives are the primary providers in the physiological model of care. They can attend births in some hospital settings, birth centers, and at a client’s home. The midwife is usually the primary interaction a client has during appointments and labor. However, some midwives work in partnership practices. In this instance, the midwife on call is the one to attend the birth.
Furthermore, there is a range within this model of care. Some providers lean towards a more holistic approach and others provide more medicalized procedures such as the glucose test and testing for GBS. All midwives watch for warning signs that might indicate a need to refer a patient to a different model of care since they work with healthy, low-risk individuals.
Other Considerations on Models of Care
What each model of care boils down to is a difference in how pregnancy and birth are viewed: as a natural physiological process or a medical event that should be monitored closely. However, some factors might play into which model of care is best suited to your needs.
First, if you are considered high-risk due to a medical condition or test result, you might have to go with a more medicalized approach to care. This can feel difficult for some people who might otherwise feel themselves drawn towards a physiological model of care. Processing these changes and still advocating for yourself is critical. Your doula can help support you through these choices and changes. Regardless, it's important to think through these things early on.
Making the Choice With Doula Support
As a doula, I love walking alongside and supporting clients as they undergo this search. Making the choice can often feel daunting. However, considering which model of care best aligns with your viewpoints of pregnancy is a great place to start.
From there, consider your health status and level of risk in your pregnancy. Talk with friends and family and ask them about providers in the area they used which fall underneath your preferred model of care. Make some phone calls and get to know your options in your community.
You Know What Is Right For You
At the end of the day, you will know what feels right to you. Aside from any developments in your pregnancy that might constrain you to one model of care over the other, it's ultimately your choice. Some people want a more hands-on approach and others prefer less intervention and medicalization. There is no right or wrong answer. Plus, it's never too late to switch care providers if your current one does not align with your birth desires and model of care.
I hope this helps clear the air a little on some of the terminology and differing philosophies behind pregnancy, birth, and postpartum out there. Connect with me if you want to learn more about building your birth team and getting the support you need for whatever model of care you fall under for your sacred journey.
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