A recent United Kingdom National Health report advised that 45% of women in the UK were unsuitable to give birth in hospital.

I love this!

Imagine if you found out you were pregnant and, rather then automatically opting in to the standard medical model of care for your pregnancy and birth, your first thought was that pregnancy was a normal, healthy state of being a woman and didn’t need to be managed as an illness. So you chose something different.

What would your pregnancy and birth look like if you opted for a wellness model of antenatal care rather then an illness model?

Wellness Model versus Illness Model

So what do I mean by that?

A wellness model of care takes a holistic approach to care, taking into account the mental, emotional, social and spiritual aspects of wellbeing as well as the body physiology. This is known as a Mind Body Spirit approach. An illness model of care focuses almost exclusively on the physiological aspects of health. An illness model looks for disease, whereas a wellness model sees health as not just the absence of disease, but a sense of wellbeing. Not just absence of pain, but feeling good.

A wellness model of antenatal care views pregnancy and birth as normal, healthy states of womanhood and looks to provide the emotional, mental, social and spiritual support to provide for a sense of wellbeing in the mother throughout pregnancy, birth and postnatal, as well as caring for the physical body.

I recently attended a planning meeting for a home birth. The appointment was at Sarah’s home. There was Sarah and her partner, plus her other children running in and out, plus two midwives and myself. We drank cups of tea and looked through photo albums of Sarah’s previous births. The meeting went for about 2-3 hours. During this time we discussed what was important to Sarah – what did she expect from us, how could we best assist her, how could we support her partner? The midwives discussed all of Sarah’s birth preferences and made it clear they were comfortable supporting her wishes. She debriefed her previous births and talked through where she had felt challenged and how we could support her better this time. Being her fourth baby, Sarah had set her intention to have a fast birth. Her midwives offered her wise advice to achieve this goal naturally. The atmosphere was relaxed, unhurried and intimate. The focus was supporting Sarah mentally, emotionally, socially and spiritually to achieve her birth vision. Toward the end of the session, the midwife performed the routine physical tests of checking baby. At the end of the session Sarah said it left her feeling confident, excited and looking forward to birthing her baby.

An illness model of antenatal care focuses on the pathology and physiology of pregnancy of birth, the assumption being that pregnancy and birth is fraught with danger to mother and baby and needs to be medically managed by the continuous process of tests and monitoring to make sure everything is ok: blood tests, ultrasounds, foetal monitoring, blood pressure checks, amniocentesis etc. It follows that birth then becomes a medically managed event within a hospital setting.

Ok, I’ve got no problem with that.

This isn’t us against them. Everything has its place. I just want to highlight the imbalance that exists in our culture. An overwhelming 98.5% of Australian consumers choose to birth in hospital. More Australian babies are born on the way to the hospital then are a planned home birth (0.5%)!

If a UK study can recommend that 45% of women are unsuitable to give birth in hospital – and that’s probably a conservative figure – then why are Australian women not able to birth without medical assistance? Where are we going wrong?

Why does this matter?

Because pregnancy and birth are normal, healthy states of womanhood. The fact that 98.5% of Australian women choose to birth in a hospital reflects that women (and their partners) aren’t being provided the information to trust birth and the innate intelligence of women’s bodies and are not being offered automatic access to a wellness model of care.

And that’s not ok.

It’s a bit like needing to fix something that isn’t broken. Rather the first supporting the normal, naturalness of pregnancy and birth, our culture jumps straight to the pathology of pregnancy and birth. That creates a culture of fear and mistrust and leads to a vicious cycle where women aren’t made aware of the true ability of their body to birth their baby with ease and without intervention.

It’s disturbing that we’ve allowed a situation where ‘normal’ birth is only seen in 1.5% of the population.

For the rest of the population, the focus on pregnancy and birth as an illness mean that women’s mental and emotional wellbeing is secondary to the outcome of a living baby. Under this system, women are prepared to put up with all manner of indignity, trauma, surgery, invasive procedures, pain and suffering ‘as long as the baby is ok’.

It doesn’t have to be this way.

You have choice and its important to understand where your choices might lead. That allows you to take responsibility for your wellbeing and not come out of your birth experience feeling a victim.

I want to have as natural birth as possible with minimal intervention.

Sound familiar?

This is something I hear women say all the time and yet their choices do not reflect their intention. If you want to have as natural birth as possible with minimal intervention you choose a wellness model of antenatal care that supports natural processes.

If you choose an illness model of care, if your antenatal care involves a focus on the pathology of pregnancy and birth, if your antenatal appointments involve the medical management and physiology of pregnancy, you might want to consider where your choices are leading and if they support your desire for natural, vaginal childbirth with minimal intervention.

A common mistake Australian consumers make is to choose obstetric-led care because they have private health insurance, believing that because it costs more it is ‘superior’. If you’ve choose an obstetrician as your primary care giver, you’ve chosen the medical management of your pregnancy and birth because that is what obstetrics is: the pathology of birth.

It doesn’t matter what you choose, as long as you are aware of where your choices are leading.

May your choices reflect your hopes and not your fears. – Nelson Mandela

It takes courage to make the choices that go against the vast majority. But if you want something different for yourself and your baby, you can’t do what everyone else is doing and expect a different result.

Courage is the ability to act on your heart, even in the face of fear.

Who holds the power?

Under an illness model of healthcare, the doctor is viewed as the authority and top of the hierarchy and the patient is at the bottom. The system operates according to a hierarchy, a bit like a military operation, where responsibility for health outcomes belongs to the doctor, and the patient plays a passive role. Under this model, there is an expectation of assumed compliance – the patient will do what they’re told because the doctor is viewed as having higher authority.

At the same time, the patient expects the doctor to ‘fix it’. This can be a happy trade off because it means the patient doesn’t have to take responsibility.

The problem with applying an illness model to antenatal care is the perception that the hospital, obstetricians, doctors and midwives have greater authority and power then the birthing woman. This has led to the common situation where women play a passive role in their antenatal care, doing what they’re told and expecting their baby to be delivered for them.

The result is a antenatal system where women aren’t actively encouraged to be the authority when it comes to their birth, and they’re not empowered to trust their body or trust themselves. Yet it is when women assert themselves and play an active role in their birth journey that women report a positive outcome.

Authority, power, responsibility and assertiveness are qualities that can be challenging for women. Yet giving birth is arguably the most powerful human experience possible.

“What are you all doing disrespecting women? Nothing comes to this Earth unless it first passes through a woman. What are you doing? You’re all nuts. You have to respect it; it’s the one and only reality that the universe blesses. All comes through the woman.” – Guru Nanek, Ecstatic Birth Foundation Series

Wouldn’t it be great if more Australian women decided to choose different?

Wouldn’t it be an empowering step if we, as consumers, demanded a different model of antenatal care based on wellness rather then illness? 

What would your pregnancy and birth look like if you opted for a wellness model of antenatal care rather then an illness model?


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