The Difference Between Midwifery and Obstectrics
Midwifery and medical obstetrics are separate but complementary professions with different philosophies and overlapping but distinct purposes and bodies of knowledge. Physicians are experts in pathology and should have primary responsibility for the care of pregnant women who have recognized diseases or serious complications. Midwives are experts in normal pregnancy and in meeting the other needs of pregnant women- the needs that are not related to pathology. In most countries, midwives have primary responsibility for the care of women with uncomplicated pregnancies.
Midwifery focuses on the normalcy of pregnancy, and its potential for health. Birth is viewed as a natural process that has profound meaning to many people and should be treated as normal until there is evidence of a problem. The possibility of complications is not allowed to preempt all other values associated with the woman's experience of bearing and giving birth to a child. Midwives are experts in protecting, supporting, and enhancing the normal physiology of labor, delivery, and breast-feeding.
The medical management model focuses on the pathologic potential of pregnancy and birth. As a specialty of medicine, the main focus of obstetrics is diagnosis and treatment of pregnancy complications and management of diseases that affect pregnant women and the babies they carry. Acknowledging the essentialness of medical care for women and newborns with serious complications, the American College of Nurse-Midwives (ACNM) requires all certified nurse-midwives (CNMs) and certified midwives (CMs) to maintain a safe mechanism to obtain medical consultation, collaboration, and referral . But, physicians have expanded the proportion of pregnancies considered abnormal or pathologic by using monitoring devices that over-diagnose complications In many instances, the distinction between risk factors and actual pathology has been lost, and women with "high-risk factors" are treated as though they have actual complications
Common Ground Between Midwifery and Medical Obstetric Practice
Although there are important differences between these models, there is also much common ground. The knowledge and skills of midwives and obstetricians overlap. Midwives read books and articles written by obstetricians and use information based on their research. Midwives do their own research and write their own articles and books, which are available to obstetricians. The midwifery model is consistent with the purposes, philosophy, and knowledge base of midwives, but it is practiced, to varying degrees, by others, including some obstetricians and family physicians.
Differences in the Relationship Between the Care Provider and the Woman
The midwifery model establishes the pregnant woman as an active partner in her own care and recognizes her as the primary actor and decision-maker. A major part of the midwife's role is providing the information and support the woman needs to make her own decisions. A midwife helps the woman identify problems and gives her information, options, and the authority to make her own choices (19). Many midwives avoid saying that they "deliver babies"; rather they "attend" the laboring woman and "catch" the baby, recognizing that the woman herself, through her labor, delivers her own child into the world. Physicians are more likely to see themselves as the key decision-makers, and most say that they "deliver" babies.
The Main Focus of Prenatal Care
The midwifery model of care makes the woman and her life the central focus of prenatal care. A large part of the midwife's attention focuses on the pregnant woman as a unique person, in the context of her family and her life. The midwife is interested in the woman's expectations and experience of her pregnancy-her perceptions and beliefs; her knowledge and opinions; her questions and worries; her satisfactions and dissatisfactions; her comforts and discomforts; her desires, decisions, and actions; and the effect of all these on her pregnancy, fetus, labor, delivery, breastfeeding, postpartum recovery, and development as a mother.
Pregnant women need a lot of information, and some need help and support to recognize and change aspects of their lifestyles or circumstances that put them or their babies at increased risk. Midwives emphasize helping women make changes conducive to a healthy pregnancy, baby, and family.
Prenatal care within the medical management model focuses primarily on the babyand screening for pathology. Medically oriented prenatal care often fails to give enough attention to the problems embedded in the lives of pregnant women, such as smoking and domestic abuse.
Continuous Presence and Hands-On Assistance During Labor
The midwifery model of care is time-intensive and relationship-intensive. Midwives use their own physical and emotional energy to encourage, support, and comfort women during birth; the medical management model, in contrast, tends to substitute more use of medical technology for more use of professional time. Researchers studying the impact of caregiver support for women during childbirth have noted that nurses who work in obstetric units with a high use of technical obstetric interventions may have little time to provide support to women in labor (
Use of Obstetric Interventions
The midwifery model of care is based on respect for the intricacy of the natural physiology of childbirth and belief that women's bodies are well designed for birth. Midwives try to protect, support, and avoid interfering with the normal processes; thus they try to avoid unnecessary use of obstetric interventions. The medical management model, in contrast, views women's bodies as very imperfect at giving birth and calls for close monitoring and control of the process.
Physicians tend to manage labor using relatively narrow criteria for what is normal and intervene when a woman's labor falls outside those criteria. Midwives may accept greater variation as within the range of normal, so long as both the woman and baby tolerate labor well. Labors that deviate from these norms are cause for increased vigilance for early signs of actual complications, but not for automatic use of interventions.
Goals and Objectives of Care
Midwives value childbirth as an emotionally, socially, culturally, and often spiritually meaningful life experience-something to be experienced positively, with potential for making women feel stronger, and be stronger, and for strengthening bonds between the mother and father, as well as the other siblings and the newborn.
Pregnancy results in a mother as well as a baby. It is important that the woman's transition into motherhood is a positive experience, that she and all members of her family make emotionally healthy adjustments to each pregnancy and birth, and that she has the means to acquire the necessary information, skills, support, and self-confidence needed to successfully assume the roles and responsibilities of motherhood.
.