Understanding the Midwifery Model of Care

Midwifery is one of the most ancient professions: since the beginning of humanity, babies have been born and guided into the world by midwives. Ancient civilizations didn’t have modern-day physicians. Instead, each community had a person to call on when the baby was coming! These early midwives often did more than catch babies. They were the caregivers for the whole community.

Over time, western medicine set standards and titles for different types of healthcare workers. We now have nurses, doctors, midwives, therapists, pharmacists, and many other types of providers. Within each subset of professions, there is even more differentiation. You could have an obstetrician (OB) or a nephrologist, both of whom are doctors. Midwifery also has different categories: for example, certified-nurse midwives (CNMs), community midwives (such as CPMs and LMs), and certified midwives (CMs) are all midwives, but they have different educational backgrounds and scope of practice.

Reading about what midwives can and can’t do in modern-day America can get confusing. Some midwives, such as CNMs and CMs, can provide hospital-based care and services that extend far beyond catching babies. Other types of midwives, mostly CPMs and community midwives, focus exclusively on pregnancy, birth, and postpartum care. Across all these different types of care, there is one thing that unites midwives: the midwifery model of care.

The midwifery model of care

A care model is a core philosophy about how care should be provided. The midwifery model of care has several themes that influence how midwives work. Each midwife has their own individual understanding and way of implementing this philosophy, but there are several things you’ll find across midwives.

Person-centered care

The midwifery model of care puts you in the center. Midwives are healthcare experts, so they know what is considered normal and when interventions are necessary. However, they also trust you to be the expert of your own body. If you tell your midwife something feels off or wrong, they trust that you know what you’re talking about. The provider-patient relationship isn’t a hierarchy, where the midwife is the only one whose opinion matters. Instead, your care is a partnership between you and your midwife.

Most appointments with midwives are longer than appointments with doctors. Midwives know that you cannot possibly have a comprehensive health exam or prenatal appointment in a mere 15 minutes. They often use the extra time to get to know you, answer any questions you may have, or explain your options in greater detail so you can make an informed choice.

Another piece of person-centered care is shared decision-making. Shared decision-making happens when both you and your midwife discuss your options and decide what is best for you together. They’ll encourage you not only to consider your physical needs but also your mental and emotional needs. Cultural preferences, comfort levels, and gut feelings all play a role in shared decision-making.

Person-centered care challenges the cultural expectation that the provider knows best. Providers have a lot of knowledge and expertise about health and well-being (it’s their job, after all!). But they cannot decide what is best for you; only you can do that.

Birth is a natural process

When it comes to pregnancy and prenatal care, there is one uniting philosophy: midwives are trained to look at birth as a natural occurrence. While doctors are specialists in illness and disease, midwives are the “experts of normal.” Midwives view pregnancy as a process to be nurtured.

The same goes for postpartum care! Midwives understand the body takes time to heal and there are many natural processes, shifts, and changes that occur after giving birth. Many of those are physical, but a lot of them are also mental and emotional. Midwives hold space for healing and rebuilding in all areas of a person’s postpartum experience.

Mind and body well-being are linked

Midwives are very aware that a person’s environment makes an impact on their overall health. They understand that health is not just physical. A midwife is likely to inquire about your stress levels and emotional health. No, they’re not being nosy! Anxiety, stress, depression, and other mental illnesses often manifest physical symptoms.

They are proactive in helping you assess all your healthcare needs and will refer you to additional providers if necessary. Whether you need help with mental health, nutrition, managing chronic conditions, or other specialized support, midwives will point you in the right direction to help address your unique needs.

Midwifery in practice

Now that you understand the midwife model of care a bit better, you may be wondering what difference it makes. Here, some statistics on birth outcomes can help illustrate the difference between midwives and other healthcare providers.

Midwife-led births have fewer interventions: there is a 30-40% lower risk of cesarean delivery when attended by a midwife and lower chance of preterm birth. Between OBs and midwives, there is no increased risk of maternal or newborn mortality or ICU for one versus the other. Many people also report increased satisfaction with their birth experience when they had midwife-led care compared to those without midwives.

These statistics cannot tell us everything. They don’t provide context on how midwives are trained to support a wide variety of patients with diverse backgrounds. They don’t demonstrate midwives’ commitment to providing trauma-informed reproductive exams or the number of midwives actively working to improve gender-affirming care and support gender-inclusive practices. And of course, they cannot demonstrate how much of a difference an individual practitioner would make in your reproductive journey.

Because midwives see people as people and treat birth and reproductive health as natural and fundamentally human, they are well-equipped to care for people throughout their lifespan. Regardless of their credentials and educational background, the midwifery model of care is the unifying factor across all midwives.