
Physiologic vs Medical Model of Birth & Your Pelvic Health
(written by Jessica Dufault, PT, DPT)
From the moment you find out you're pregnant, one of the most important factors for how your pregnancy, birth and postpartum recovery will go is who you choose as your provider.
And, even more specifically, which model of birth your provider practices within.
Physiologic versus Medical Model
Midwives are typically trained under the physiologic model.
OBGYNs are trained under the medical model, to support higher risk pregnancies and births.
It’s important to note that these models of birth fall on a spectrum and providers may vary where they fall along the spectrum also!
Some midwives may be more “medical birth” minded and some OBGYNs may be more “physiologic birth” minded.
There is a time and place for both models of care and type of provider, which is why understanding the difference between the two models is critical for getting the birth you desire.
This discussion will be especially helpful for you if you are someone who is planning a low-intervention and possibly unmedicated hospital-based birth. It's also helpful if you are someone who is thinking beyond birth and considering the impact that birth can have on the lifetime of your pelvic health.
The Physiologic Model of Birth
This model believes that birth is natural and has a spontaneous onset and progression and includes the conditions that promote effective labor. It promotes:
✔️labor to start on its own
✔️use of natural oxytocin
✔️minimal disruption and intervention
✔️autonomy for how you use your body
✔️choices for birth positioning
✔️ your decision making power
✔️ improved birth experience and satisfaction
The Medical Model of Birth
This model views birth as a medical event. And, factors within the medical model disrupt the normal, physiologic birth process, such as:
✔️ unnecessary and routine procedures such as inductions, episiotomies, cervical checks and more
✔️ unsupportive environment
✔️ time constraints driven by hospital policy or staffing
✔️ limiting your food, water and even movement
✔️ birth happening in just one position
✔️you becoming a patient which means someone else is "in charge" to make decisions
But here is something to know!
Even with a provider that practices under the medical model (this is where 90% of births happen!), you can advocate for yourself and shift more toward the physiologic model or toward a more “physiologic” minded provider. Here is why your postpartum pelvis may want to consider this.
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Protection of Your Pelvic Floor: The physiologic model often leads to a lower risk of pelvic floor injury. Interventions that increase risk for tearing (episiotomy, purple pushing, forceps or vacuum) are used significantly less often.
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Reduced Risk for Other Injury: Lower risks for things like pelvic organ prolapse, hernias, hemorrhoids and more
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Better Postpartum Recovery: Less medical intervention can result in a smoother postpartum recovery
Advocating for Your Ideal Birth in the Medical Model
I believe you can have your ideal birth within the medical model but it will be crucial for you to advocate for yourself and PLAN ahead. Again, who you choose as your birth provider is an essential part of your birth experience.
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Informed Decision-Making: Understanding ALL the differences between the two models allows you to make more informed decisions about your birth plan. Discuss your preferences with your birth team ahead of time and create a plan together (in detail!) that aligns with your wishes.
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Communication: Open and direct communication. As birth unfolds, continue to advocate for yourself about your desire for minimal intervention and the physiologic approach, but also know that you may need to flexibly adapt to medical recommendations if a true need arises.
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Support: Consider hiring a doula or a birthing advocate who can provide emotional support and help you navigate things that may come up under the medical model that you might not have prepared for. They can be your voice!
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Birth Prep: Learn proven strategies to optimally prepare your body for birth. Learn tools to implement during birth that will help you work with the physiologic process.
Both models of care are important. For normal, healthy, non-emergency births, the physiologic model aligns better with natural processes, increased birth satisfaction and reduced impact on the lifetime of your pelvic health.