THE TECHNOCRATIC (MEDICAL) MODEL OF BIRTH |
THE HOLISTIC (MIDWIFERY) MODEL OF BIRTH |
| Male Perspective |
Female Perspective |
| Male-centered |
Female-centered |
| Woman = Object |
Woman = Subject |
| Male body = Norm |
Female body = Norm |
| Female = Defective male |
Female normal in own terms |
| Classifying, separating approach |
Holistic, integrating approach |
| Mind is above, separate from body |
Mind and body are one |
| Body = Machine |
Body = Organism |
| Female Body = Defective Machine |
Female Body = Healthy Organism |
| Female reproductive processes dysfunctional |
Female reproductive processes normal, healthy |
| Pregnancy and birth inherently pathological |
Pregnancy and birth inherently healthy |
| Doctor = Technician |
Midwife = Nurturer |
| Hospital = Factory |
Home = Nurturing Environment |
| Baby = Product |
Mother/Baby = Inseparable Unit |
| Baby grows itself through mechanical process |
Intimate connection between growth of baby and state of mother |
| Fetus is separate from mother |
Baby and mother are one |
| Safety of fetus pitted against emotional needs of mother |
Safety and emotional needs of mother and baby are the same |
| Best interests of mother and fetus antagonistic |
Good For Mother = Good For Child |
| Supremacy of technology |
Sufficiency of nature |
| Importance of science, things |
Importance of people |
| Institution = Significant Social Unit |
Family = Essential Social Unit |
| Action based on facts, measurements |
Action based on body knowledge and intuition |
| Only technical knowledge is valued |
Experiential and emotional knowledge valued as highly as or more than technical knowledge |
| Appropriate prenatal care is objective, scientific |
Best prenatal care stresses subjective empathy, caring |
| Health of baby during pregnancy insured through drugs, tests, techniques |
Health of baby insured through physical and emotional health of mother, attunement to baby |
| Labor = Mechanical Process |
Labor = A Flow of Experience |
| Uterus = An Involuntary Muscle |
Uterus = Responsive Part of Whole |
| Time is important; adherence to time charts during labor is essential for safety |
Time is irrelevant; the flow of a woman's experience is important |
| Birth must happen within 26 hours |
Labors can be short or can take several days |
| Once labor begins, it should progress steadily; if it does not, intervention necessary |
Labor can stop and start, follow its own rhythms of speeding up and slowing down |
| Some medical intervention necessary in all births |
Facilitation (proper food, effective positioning, support) is appropriate, medical intervention usually inappropriate |
| Environmental ambience is not relevant |
Environmental ambience is the key to safe birth |
| Woman in bed hooked up to machines with frequent exams by staff is appropriate |
Woman doing what she feels like - movement, sexual play, eating, sleeping - is appropriate |
| Labor pain is problematic, unacceptable |
Labor pain is acceptable, normal |
| Analgesia and anesthesia for pain during labor |
Mind/body integration, labor support for pain |
| Iatrogenic (doctor-caused) pain is acceptable |
Practitioner must strive not to cause pain to the woman |
| Once a Cesarean, always a Cesarean for many women; VBAC high risk |
Vaginal birth after Cesarean (VBAC) low risk, normal |
| Unusual presentations, such as breech, require severe intervention, usually Cesarean |
Midwifery techniques for unusual presentations - e.g., external version or delivery on hands and knees for breech |
| Birth = A service medicine owns and supplies to society |
Birth = An activity a woman does that brings new life |
| Obstetrician = Supervisor/Manager/Skilled Technician |
Midwife = Skillful Guide |
| The doctor controls |
The midwife supports, assists |
| Responsibility is the doctor's |
Responsibility is the mother's |
| The doctor delivers the baby |
The mother births her baby |