Choice-centered childbirth

Feet and arrows on road background. Pair of foot standing on tarmac road with colorful graffiti arrow sign choices

Contemporary midwives and their advocates suffer from a lack of imagination. They view childbirth in Manichean terms, pitting the so-called midwifery model against the so-called biomedical model. It’s a false duality.

There is a framework for maternity care that rises above both. It’s a framework that should govern the provision of all childbirth care. I call it the choice-centered model of childbirth.

Choice-centered childbirth puts control back to where it belongs: with mothers themselves.

How did we arrive at a false duality?

Modern obstetrics has been spectacularly successful. Science based childbirth has led to an extraordinary drop (over 90%) in both perinatal and maternal mortality in only 100 years.

Indeed, as Dr. Atul Gawande has noted:

Nothing else in medicine has saved lives on the scale that obstetrics has.

Moreover, modern obstetrics has made childbirth more easily endurable. Epidural anesthesia has freed women from pain so excruciating that the ancients could only imagine it as a punishment from God.

In response to their loss of market share to science-based childbirth, midwives have spent the past 40 years promoting grievance-based childbirth.

Grievance-based childbirth starts from the assumption that midwives “own” childbirth and doctors have stolen it from them. It postulates — laughably — that doctors medicalized childbirth for their own benefit and ignores the fact that obstetricians have made childbirth safer in three generations than midwives managed in thousands of generations.

Grievance-based obstetrics insists – preposterously and with no evidence — that childbirth prior to modern obstetrics was a peak spiritual experience for women and that doctors have stolen that imaginary experience away from them.

Of course, midwives don’t refer to it as grievance-based childbirth; they wouldn’t attract many customers by accurately portraying their attempt to claw back market share. They call it “natural” childbirth even though the only thing natural about it is midwives’ lack of life-saving skills.

The false duality of natural childbirth vs. biomedical childbirth results from a fundamental misunderstanding of the locus of control in childbirth. Midwives imagine that childbirth should be governed by their preferences as opposed to by the preferences of obstetricians. Choice-centered childbirth puts control back to where it belongs: with mothers themselves.

In choice-centered childbirth, all choices are valid.

– The choice to forgo interventions is valid as is the choice to opt for maximal interventions.
– The choice to experience the pain of childbirth is valid as is the choice of an epidural.
– The choice to wait for labor to begin on its own is valid as is the choice for induction.
– The choice to avoid a C-section is valid as is the choice to have one by maternal request.
– The choice to room-in is valid as is the choice to send a baby to the nursery.
– The choice to breastfeed is valid as is the choice to formula feed or combine both.

As a result, childbirth education would involve presenting the complete menu of existing choices, not just the ones of which midwives approve.

In others words, midwives and natural childbirth advocates would be forced to respect women’s choices instead of trying to manipulate them. How radical!

  • fiftyfifty1

    I have noticed that midwives also use abortion as a sort of weapon in their grievance-based argument. I have read statements claiming that not only did midwives own childbirth, but they also owned abortion. In these halcyon days of yore, supposedly abortion was legal and safe. But then doctors “stole” all reproductive services from midwives making childbirth awful and abortion illegal. Yeah sure.

  • Sue Ieraci

    When midwives are specialised nurses who work within a health care team, and are motivated by professionalism rather than ideology, women CAN have a choice.

    Low-risk women having uncomplicated births can choose midwifery care in hospital, with consultation/escalation to OBs or anesthesiologists as required. That’s the model for the vast majority of public hospital births in Aus.

    • fiftyfifty1

      Or women could just start off in OB care and get all of their choices there. After all, an OB can do it all, from minimal-intervention all the way to maternal request CS. Of course midwives are cheaper, as they have less training so they get paid less. But the advantage of starting off in OB care is that no transition is needed in the middle of labor if and when a woman needs more intervention.