There are differing approaches to the practice and philosophy among professionals who can attend births. Most caregivers fall into one of two categories, although many find themselves somewhere in the middle of these two generalizations.
The first approach is the medical approach. This approach assumes that there are potential dangers and risks inherent in pregnancy, labor and birth. The primary role of the caregiver is to safely avoid these dangers, be aware of and know how to deal with potential complications and variations that arise and intervene in such situations. They are more likely to monitor and test for these issues and complications.
The midwifery approach assumes that pregnancy and birth are normal and natural processes. The caregiver in this model primarily serves to monitor the mother’s physical, psychological and social well-being. This approach is most likely to focus on education and assistance, and help explore alternatives for coping with complications, and generally attempting to minimize technical interventions.
Each approach has its merits and its pitfalls. Often, the medical approach may wind up using techniques that are unnecessary or burdensome to err on the side of safety. On the other hand, the midwifery approach may miss serious health issues that could put the health or life of mother or baby at risk. There are arguments on both sides that will tell you their position is “safer”; however, the issue of safety may very well be an individualized one.
If you have a high-risk pregnancy due to a serious chronic medical condition like high blood pressure, diabetes or heart disease you should likely see an OB-GYN. If you discover you are having twins or if complications develop during your pregnancy you may need to switch to an OB-GYN. If you already have a practitioner with whom you are comfortable for pre-pregnancy care, you may wish to stay with that practitioner.
If you are seeking an individualized, less routine experience, a midwife may be a good choice. A midwife may have more time to answer questions, and will generally be able to assist with social and psychological issues that an OB-GYN may not be able to. If you wish to have a birth at home, you will likely need a midwife. If you cannot find an OB-GYN whose intervention rate you are comfortable with you may need a midwife.
Regardless of whether you choose an OB-GYN or a midwife you should be certain to do your homework on the individual. You should know their philosophies and approaches to medical intervention. You should be aware of their level of expertise, and be certain of their training and their qualifications. This is particularly important in the case of a direct-entry midwife, as the requirements vary greatly for this type of midwife.
