Text of a paper I originally submitted November 23, 2013 for MDWF 100 at Midwives College of Utah
By continuously watching over, sustaining and seeking to shelter their clients, midwives help mothers achieve satisfying birth experiences and excellent birth outcomes. These ideals form the four cornerstones of what is known as the Midwives Model of Care™. The first cornerstone of watching over denotes “monitoring the physical, psychological and social well-being of the mother throughout the childbearing cycle.” The second cornerstone, sustaining is “providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support.” The third and fourth cornerstones fall under the definition of seeking to shelter, which includes “minimizing technological interventions” as well as “identifying and referring women who require obstetrical attention” (Citizens For Midwifery, 2005). In combination, these evidence-based ideals bring about the positive results for which midwifery has come to be distinguished (Wagner, 2006, p.228).
Midwives have confidence in the natural unfolding of the birth process (p.104-15) because, in most cases, their training and method of providing care enables their patients to achieve satisfying, minimally disrupted birth (Sakala & Corry, 2008). Midwife-provided maternity care is a universal feature scholars have come to associate with nations that have lower infant and maternal mortality rates than the United States (as cited in Wagner, 2006, p.9, 243). Midwives establish a relationship of trust through prenatal visits that typically last 24 minutes, during which they not only conduct the health evaluations customarily expected, but also take the time to check-in on how a woman is doing in all aspects of her life (Wagner, 2005, p.106-107). During birth itself, as the Coalition for Improving Maternity Services, or CIMS, outlined in their 2007 study, midwives typically remain a constant comforting presence (p.10S-19S). This is good news for mothers, since midwives have been proven to be safer attendants than obstetricians for low risk women (as cited in Wagner, 2006, p.245). After their clients give birth, midwives remain interested and involved. Their encouragement helps new mothers adapt to the demands of motherhood, breastfeeding and infant care (CIMS, 2007, p.74S-76S).
Women who receive prenatal care from midwives not only have longer consultations but more of them. This is because of the high level of personalized instruction and empathetic advice that they receive (p.13S). This trend may partially be explained by the cultural humility most midwives exercise (p.23S-24S). Midwives typically provide continuous labor support, the key factor in mitigating the downward spiraling processes that often have their origins in pharmaceutical or instrumental interventions (Sakala & Corry, 2008, p.53-54). Midwives know that if left undisturbed, a mother’s body will respond to childbirth with a beneficial cascade of hormones that ease and assist the process, assuring the formation of a deep bond between a woman and her baby (Sakala & Corry, 2008, p.4, 25-26). Therefore, midwives guide mothers through the journey of birth, such as by suggesting beneficial labor positions, encouraging ambulation and supporting choices such as free delayed cord-clamping (p.4-5; CIMS, 2007, 23S-27S) all of which are often underutilized in other models of care (Sakala & Corry, 2008, p. 40-41). In the postpartum period, it has been shown that midwife support encourages breastfeeding, especially in circumstances where mothers might not otherwise choose to start or continue in the practice ( p.56).
Seeking to Shelter
In 2013, Sandall, Soltani, Gates, Shennan and Devane conducted a meta-analysis of 16,242 women included in 13 studies of midwife-provided care. While there were no differences found in the rates of cesarean birth and fetal loss or death during and after the third trimester, these researchers discovered that midwifed mothers experienced lower rates of fetal loss before the third trimester, and birthed more frequently without requiring local or regional pain medication, episiotomy, epidurals, or forceps/vacuum assistance. While their labors lasted a bit longer on average, midwifed mothers achieved unassisted vaginal birth more often. (p.11-12, 17-18). In a prospective study of 7,214 planned homebirths under the care of certified professional midwives (CPMs), researchers Johnson and Davis provided conclusive evidence that low-risk women attended by midwives attain safer outcomes than counterparts attended by obstetricians in hospitals. This finding proved true in all categories, from maternal and infant mortality rates to obstetrical intervention (as cited in Wagner, 2006, p.142-143). The Midwives Model of Care™ supports all ten steps of mother-friendly care endorsed by CIMS, including step 6, which advocates using evidence-based birth modalities (2007, p.32S-64S) and step 7, which discourages the use of drugs during labor and recommends drug-free alternatives (p.63S-73S).
Midwives also know that sometimes certain pregnancies require a larger umbrella of protection. They are proactive in expanding the circle of care to include themselves and obstetricians (Wagner, 2007, p.203). It has been shown that mothers with high-risk pregnancies receive optimal care when practitioners of obstetric and midwifery science are able to collaborate successfully (CIMS, 2007, p.28S-31S).
Sakala and Corry outlined four conditions that contribute to greater maternal satisfaction with birth: “amount of support from caregivers, involvement in decision making, quality of mother-caregiver relationship and having high expectations for childbirth met or exceeded” (2008, p.52-53). Since studies have shown that women who receive care from midwives report higher rates of satisfaction (Sandall et al, 2013, p.16, 18; Wagner, 2006, p.106), Sakala and Corry’s conditions are met in the Midwives Model of Care™, especially in terms of labor support (CIMS, 2007, p.11S ). In addition to avoiding adverse outcomes, such as those connected to cesarean sections (Sakala & Corry, 2008, p.42-26) mothers are empowered to exercise preventative medicine on behalf of their children. Research is only beginning to discover the long-lasting negative ramifications that pharmaceutical and instrumental interpositions have upon infants (p.4,31-34). Because they have hormonally bonded to their infants (p.25-26), midwifed women can also enjoy positive benefits, such as those associated with professionally supported breastfeeding (CIMS, 2007, 79S-80S).
As the cited studies have demonstrated, midwives know the power and efficacy of trusting mothers and trusting birth. Through their adherence to the ideals of Midwives Model of Care™, midwives are a proven catalyst for good in the lives of women, infants and their families.
Citizens for Midwifery (2005). The Midwives Model of Care. Retrieved from http://cfmidwifery.org/mmoc/define.aspx
Coalition For Improving Maternity Services (2007). The coalition for improving maternity services: Evidence basis for the ten steps of mother-friendly care. Journal of Perinatal Education, 16, (1-Supplement). Retrieved from http://www.motherfriendly.org/Resources/Documents/CIMS_Evidence_Basis.pdf
Sakala, C., & Corry, M. (2008). Evidence-based maternity care: What it is and what it can achieve. Childbirth Connection, the Reforming States Group and the Milbank Memorial Fund. Retrieved from http://www.milbank.org/uploads/documents/
Sandall, J., Soltani, H., Gates, S., Shennan, A., & Devane, D. (2013). Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database of Systematic Reviews, 8, CD004667. doi:10.1002/14651858.CD004667.pub3.
Wagner, M. (2006). Born in the USA: How a broken maternity system must be fixed to put mothers and infants first. Berkley and Los Angeles, CA: University of California Press.