This was originally an assignment in a midwifery course. I've shared my thoughts here in hopes it helps other birth workers serve all birthing people with dignity and thoughtfulness. To read the original format of the assignment and/or references, click here.
A particularly intriguing birth model is that of a simple triad of support consisting of an obstetrician, midwife, and doula as presented by Ricardo Jones. When reading Jones’ chapter, three major themes common among successful models of birth are apparent. First and foremost, evidence-based practice is key, which can be understood as the place where client values, provider experience/opinion, and quality research intersect. Not only does Jones make specific mention of evidence-based medicine being an important component to his career, he also absorbs and applies others’ works, papers, and data around evidence-based birth in order to improve his practice (Jones, 2009).
The second prominent theme is that of a patient-centered approach often exhibited by successful birth models. Jones and his team consciously keep the birther and family at the center of their practice; this is evident when Jones notes that his team’s low-risk clients can choose to birth at home or in the hospital, even sometimes deciding during labor if one place ends up being more comfortable than the other. On this, Jones (2009) argues “the main idea should always be the well-being and safety of the woman, while offering full agency to the couple in the decisions made (p. 295). In this model, the unique flexibility on the practitioners’ parts serves to honor and promote the autonomy of the birther.
The third theme in Jones’ approach might be easily overlooked considering his chapter is written from the obstetrician’s point of view. Though Jones worked with the doula as a team before his wife joined their practice, it is she as the nurse-midwife who takes lead once home births enter the scene (Jones, 2009). A practitioner of the midwifery model of care being the primary professional at birth is an important component that leads to improvement of outcomes in most successful birth models. Having the addition of an obstetrician who can take direction from, learn from, and swap places with a midwife partner when needed affords families dynamic care in all potential settings. Additionally, the midwife and obstetrician rely on the doula to fill in the gaps in care that they cannot fill, such as providing massage for many hours or attending families in very early labor (Jones, 2009).
This small-team collaboration model has the potential to be a game changer in a community. Though it is unclear if Ricardo Jones is actively practicing as an obstetrician within this framework, this model and slight variations are utilized in multiple places. In Los Angeles, an out-of-hospital provider named Dr. Stuart Fischbein collaborates with local midwives and doulas often to support families not otherwise able to have home births due to state law. In Guadalajara, Plenitud is a practice made up of multiple midwives and obstetricians who attend births in homes and a birth center; doula support here is also common.
One potential barrier to this model of birth is that it may not be financially feasible for the obstetrician or could lead to only the most affluent being able to attain the collaborative care. Though Jones (2009) shares that obstetricians in Brazil are not required to carry insurance, malpractice protection is standard for physicians in many other places, and rates for out of hospital doctors might be prohibitive. Perhaps an even greater barrier, though, is that this birth model can only be replicated if the will of an individual practitioner to examine and alter their own attitudes, practices, and outcomes surpasses their desire for financial security and socio-professional acceptance. At multiple points in his career, Ricardo Jones clearly identified barriers to the results he desired and set out to change his approach to humanize birth. He notes that he spent more than a decade in a “period of silence, introspection, solitary study, and professional isolation” (p. 283). Given these barriers, it is not surprising that this model is not common around the globe. It seems that only an individual of great self-awareness, professional courage, and personal purpose would be successful as an obstetrician choosing to work outside of the designated system.
Amanda Cagle is a professional doula, educator, and student midwife located in Orange County, CA who offers comprehensive services to growing families and birth professionals alike. Amanda can be reached via email at firstname.lastname@example.org or through www.yourbirthteam.com.