One of the kids’ science magazines just arrived. This month’s theme: Growing Up. Much of the focus was on animals—hatching eggs, metamorphosis, how puppies are born. But one story was about—go on, guess—human gestation. Pregnancy.

The story is set up as though the narrator is speaking to the child-reader. When you were in your mommy’s tummy, this happened! And then this! Like that.

So I read it with the kids, which led to them asking all sorts of good questions:

Why does it say the mom will see a doctor? Why doesn’t it say “doctor or midwife?”

Why does it say the baby was born in a hospital? Why doesn’t it say “might have been born in a hospital?” Or “some babies aren’t born in hospitals?”

Why is the mom lying down when her baby is born?

Dear magazine-makers: when my nine- and six-year-olds can create a more accurate and inclusive description of birth than your educational content providers did, you may have a problem.

And then the kids and I got to discuss, just a little and at an age-appropriate level, why some women choose midwives and some choose doctors.

People often think we use a midwife because she’s friendlier than a doctor, or because we like her more. Um… no. We are friendly with our midwife. We live in the same neighborhood. Our kids have been to each other’s birthday parties. Our personalities mesh well. But I first hired her because she’s an excellent midwife. And I preferred to be attended by a midwife rather than a doctor both because I wanted to give birth in a particular location (home), and because I wanted a health care practitioner that followed the midwifery model of care (as opposed to the medical model of care).

The midwifery model of care, though, doesn’t mean “care provided by a midwife,” just as the medical model doesn’t mean “care provided by a medical doctor.” Each model describes a different philosophy of care, and involves different practices and norms; each is associated with different outcomes. There are valid and logical reasons for choosing each of these models, and both have a rightful place in our health care system.

The midwifery model focuses on health, wellness, and prevention, while the medical model focuses on managing problems and complications. (The midwifery model also pays special attention to identifying and referring those women who need obstetrical intervention.) Care is individualized in the midwifery model, and made routine in the medical model. The midwifery model is associated with lower rates of intervention, and with higher maternal satisfaction. It also fits with and honors my personal belief that—under normal circumstances—my body was made to be able to give birth.

There are doctors who follow the midwifery model, and some midwives who more closely follow the medical model. (Some have argued that the models should be called the physiological model and the pathological model, to better describe them, but those names haven’t really caught on. Go figure.) Asking a few pertinent questions can usually help a woman determine what model of care a birth attendant embraces.

Not everybody believes what I believe; not everybody wants the same things I want in a birth attendant. But there are real and measurable differences between these two models of care, and we should each be able to choose a birth attendant whose philosophy best suits our circumstances and our values. Which philosophy fits us best is something we can each decide for ourselves. Of course.

For more information on these models of care:
The Midwifery Task Force’s brief definition of the midwifery model of care is available here. An expanded explanation can be read here.

Our Bodies, Ourselves offers definitions of both the midwifery model of care and the medical model of care. Childbirth Connection also compares the two models.

I don’t know how you squeezed your big old spider body through the window screen, but I see that you did. Was my shiny white kitchen sink so enticing that you had to abandon your shadowy web in the crevice of the eaves outside? Does this look like the obvious place to set up shop and rake in the bugs? Are you just really into fruit flies? (And if so, are you on a low-cal spider diet? Because we won’t really have a problem with fruit flies until we have summer fruit.)

Methinks it matters not, because I just rinsed you down the drain. Yes, yes, I maybe could have caught you and relocated you, but you kept darting away from me, and really, if you come into my house with weird poisonous-looking markings and stripey legs, you should either cooperate with me or expect a quick demise.

Remember that next time. (Oh wait, you can’t.) Well, tell your friends. (Hmm, nope.) Let this be a lesson… okay, there may be no take-away here. Spiders of the world, take note. And stay out of my sink.

Love,
Me

And, though I don’t have writer’s block—I have thinker’s block—I say, “What’s that?”

“Doing the dishes while I run to the store!” And here he smiles charmingly.

“Sadly,” I say, “I already planned to clean the bathroom.”

But thanks to his expert negotiating skills, I end up doing the dishes and cleaning the bathroom after all; he deals with the laundry and sweeps the floors.

And still I have a touch of the thinker’s block. So what I have for you, in lieu of an actual coherent post, is a list of bullet points.

- Teaching kids self-sufficiency is awesome. It also leads to the nine-year-old accidentally sweetening our pot of oatmeal with mango tea instead of apple juice. Or at least it did today. The good news: mango tea in oatmeal is tasty. The bad news: I’m not super-sure it wasn’t caffeinated. (The package didn’t indicate, either way.) Now I’m wondering why no one has ever marketed caffeinated oatmeal before. Seems like there’d be somebody willing to buy that.

- The kids had a stellar two-hour quiet time today. (Insert raucous applause here.) Quiet time has been a little bit, um, nonexistent since the younger girls gave up their naps, but today it went very well indeed. I have hope for the future of quiet time once again. And to go along with the quiet, I was sicker than I’ve been in days, so I mostly just sat on a sunny patch of floor and rested my head. For the whole two hours. Bah, who needs productivity! Yeah, me.

- At my midwife’s suggestion, I checked a pilates video out from the library. Because while in theory I’m sure I’d love to take a regular prenatal yoga/pilates/miscellaneous fitness class, I think we can all recognize that it ain’t gonna happen. Thus far my video has taught me that even in pregnancy, posture is an attainable goal. Which is good, in case I was worried that one of the side effects of pregnancy might be that all my bones would turn to pudding. In related news, if anyone has a different prenatal pilates video to recommend, go right ahead.

And with that, we shall end our bulleted list. Feel free to return to your regularly scheduled… um… your regular… uh… schedule. (Thinker’s block. Strikes again. It’s serious.)

“Okay, kids! Bedtime!”
Means: So I can eat another cupcake.

“Oh, I don’t know what I want for dinner.”
Means: How many cupcakes do I have to eat before it’s a meal?

“Are you going to run to the store?”
Means: So I can eat a cupcake without having to share?

“I think we’re out of breakfast things.”
Means: There will be no more cupcakes left by morning.

I think it was a combination of circumstances and personality.

I’m a research-happy kind of person. Before making decisions, I have a pathological need to read up on all possible choices first, and talk at length (mostly to my long-suffering husband) about what I’ve learned, and then decide which of my options I think is best. I’m a little nutty that way.

I started out reading books like A Good Birth, A Safe Birth (no longer in print). But I was also just out of college when Abigail was born. My degree had required classes in advanced statistics and research methods and experimental design—so fun! and I’m not even joking!—and I still had access to medical journals through the university’s library system. And I think I mentioned, I love me some research.

I probably didn’t need to look that hard to find information on best practices in maternity care, and certainly no one needs to do that anymore. But once I knew what to ask about, it wasn’t difficult to find out which practitioners and which birth locations followed evidence-based best practices, and also which were able to accommodate the practices that were most important to me.

If I were researching today, I might start with some of these sources:

- Henci Goer’s articles and books. The Thinking Woman’s Guide to a Better Birth is aimed at pregnant women, and Obstetric Myths versus Research Realities is aimed at medical professionals.

- Jennifer Block’s articles and book, Pushed.

- Marsden Wagner’s book, Born in the U.S.A.

- Adrienne Lieberman’s Easing Labor Pain, an overview of all sorts of pain management options.

- Sheila Kitzinger’s Complete Book of Pregnancy and Childbirth, for information on healthy pregnancy and childbirth in any setting.

If I wanted to learn more about out-of-hospital birth choices, I might read these:

- Citizens for Midwifery’s resources page. There are links to news, studies, opinion, and explanation.

- Ina May Gaskin’s Spiritual Midwifery, a classic collection of home birth stories.

- Ina May’s Guide to Childbirth, which is all about natural childbirth.

- Mothering Magazine, in print or online, which regularly includes out-of-hospital birth stories and articles on natural childbirth.

If I wanted to know more about the midwifery model of care (as opposed to the medical model of care), I would look into these:

- North American Registry of Midwives. NARM licenses Certified Professional Midwives. CPMs are often direct-entry midwives (midwives who are not also nurses).

- In the U.S., the American College of Nurse-Midwives. CNMs are first trained as nurses, and then receive additional training as midwives. They might attend births in hospitals, freestanding birth centers, or homes.

- Midwives Alliance of North America. MANA is an advocacy organization for all types of midwives.

- Citizens for Midwifery is a consumer group that advocates for midwifery and midwives in the U.S.

- The Big Push for Midwives campaigns for the regulation and licensure of Certified Professional Midwives in all 50 U.S. states.

- Heart and Hands: a midwife’s guide to pregnancy & birth, an accessible midwifery textbook that you can probably find at your library.

I would also interview the health care providers I was considering hiring. (I did this when I was pregnant with Abigail. Midwives expected it, and scheduled in-person consultations. Doctors and hospitals, I mostly interviewed over the phone, and sometimes I spoke to an office’s “medical assistant” rather than to the obstetrician.)

I had a long list of questions—among other things, I wanted to know how often they dealt with various complications, how regularly they performed various interventions, and, for out-of-hospital practitioners, how often they transferred care and under what circumstances. Their answers, as well as how comfortable they were being questioned, gave me enough specific information to choose the best health care provider for me. Presumably another woman, interviewing the same practitioners, could come to another conclusion based on what was important to her. And that, I think, is as it should be.

I know that not all options are available to every woman. In the real world, we’re constrained by money (which locations and health care providers will your health care plan pay for, if you have one? can you afford to pay out of pocket for other options?), by location and transportation (can you get to the birth location of your choice? can a health care provider get to you?), and by state and local politics (are midwives legal in your area? if so, are there any? and if they practice out-of-hospital, do they have good working relationships with local obstetricians, allowing for supportive transfer to a hospital in case of complication?). But for women who do have options, I hope resources like these are helpful.

What have I missed? What resources helped you decide where and how to give birth? Are there books and websites available now that you wish you’d had access to years ago?

She was born just after midnight, a week past her due date. There are so many things I could tell you about that birth—how I didn’t know I was in labor and didn’t believe it when my midwife said I was; what happened when Abigail and Owen woke up for the birth; how Audrey seemed to know all of us, not just me, right from the moment she was born; or… well, there are a lot of good parts to that story, and this is a short blog post, so we’ll save it for another time.

Audrey has big plans for being four. She’s been counting down the days, and talks about all the things she Will Do when she’s four, and all the other things that she Won’t Do Anymore when she’s four. I remember that Abigail fervently believed, when she was three, that four was the age of being allowed to chew gum. No one’s suggested that to Audrey yet, though. Audrey’s list remains entirely her own.

When I was pregnant with her, I was worried that my labor would go so quickly that the baby would arrive before our midwife did. (When Owen was born, I was in labor for all of ninety minutes.) That didn’t happen, not at all, but Audrey had plenty of other surprises in store for us. I’m sure she still does. Let’s see what four brings, shall we?

Happy birthday, girl of mine. May four be everything you imagine, and then some.

Yeah, note to self: When you hear yourself saying, Eh, who needs to check the weather? Uh-huh, you need to check the weather. Or else you’re going to spend the morning fake-cheerily telling small people to put your hands in your pockets! You’ll hardly notice how chilly they are! And also making excuses for the sad lizards that are asleep in their hidey-holes instead of sunning themselves out in the open like usual.

Ah, the great outdoors!

Abigail asked over the weekend whether I would be sad to not have three-year-old Audrey anymore, and of course I will, a little, because four-not-three means she’s one step closer to grown, and done with being a child, and waaah where did my sweet babies all go, but mostly I’m not. Sad, that is.

I adore squishy little newborns and big, chunky babies. Toddlers I think are both exhausting and delightful, especially when they’re not scaling the stove in the kitchen. And then they just keep getting more fun. Still plenty of work to parent, of course, but fun.

I love getting to watch the older kids develop opinions and ideas and plans for the future. I think it’s really cool to see how their skills and preferences and tendencies now, may lead them to their areas of expertise later. Plus they’re neat to talk with and listen to and teach and learn from and explore the world with.

Audrey will never be three again, that is true, and it’s always a little bit melancholy to walk away from something for the last time. But she’s walking toward something too, something just as good that will keep on getting better.

“And,” Abigail reminded me, “in, like, half a year we’ll have another three-year-old anyway.” Because that’s how long until Sadie’s next birthday, when she will indeed turn three. The two girls aren’t interchangeable, but I see her point. No use missing something when there’s plenty more to come. I can get behind that kind of logic, too.