Wednesday, February 18, 2009

Private Practice: Dell the "Midwife"

I've decided there are three issues I want to address from the "Acceptance" Private Practice show: Dell as a midwife; electronic fetal monitoring & fetal heart tones; and informed consent in general & regarding the vacuum extractor in particular. I haven't gotten to this until now because my little guy woke up with a stomach bug at 2am, and was in rough shape all morning. Thankfully he seems okay now.

So I'm really curious about how you all feel about Dell as a midwife. In case you missed it, I outlined the show I'm discussing in my previous post, Private Practice: "Acceptance".

First, there's the whole gender issue - should men be midwives?? That's not going to be the focus of this post... I guess I think men should be able to become midwives if they want, but I'm wondering how many women would choose to have a male midwife? Is there really a market for male midwives? Clearly male midwives are rare - I don't know of any practicing in Maine.

Anyway, I think Dell's character is an interesting foil for Addison, in that he portrays some stereotypically feminine characteristics while she portrays some stereotypically masculine ones. While the gender issue may be one that the producers/writers are trying to challenge viewers with by having Dell pursue midwifery, gender is not the important issue for me.

Feel free to leave a comment re: your feelings on male midwives (especially you, Michelle, since you actually received care from a male midwife).

The real issue for me is that viewers are watching Dell, a "midwife", act in ways that are not at all based in reality in terms of midwifery care. Dell, the "midwife", has a woman birthing her baby flat on her back. The first solution proposed when the baby might be experiencing difficulty is a risky, technological one. As a "midwife" he is being trained by Addison, a high-tech neonatal surgeon and obstetrician, and Naomi, a high-tech fertility specialist and obstetrician. What???

People. That is NOT midwifery.

This is not to say that there might be some in-real-life midwives who prefer working with women in the lithotomy position (flat on back), and who use lots of technology. Unfortunately, there are midwives like that; some people call them "medwives". The frustrating thing is that when mainstream media calls Dell as a midwife, it makes it even harder for people to understand the real differences between the Midwifery Model of Care and the Medical Model of Care. Dell's care of that birthing mom in "Acceptance" is not Midwifery Model care!

Here's a link to the excellent Childbirth Connection page on midwifery care. Below is their discussion on the Midwifery Model of Care and the Medical Model of Care:
"Views of the childbearing process and of appropriate care for childbearing women vary. Two contrasting perspectives are often called the "Midwifery Model of Care" and the "Medical Model of Care." There are striking differences in the two models. These differences can have a great impact on your experience and outcomes.

Here are some contrasts between the two models:

Midwifery Model of Care
Focus on health, wellness, prevention
Labor/birth as normal physiological processes
Lower rates of using interventions
Mother gives birth
Care is individualized

Medical Model of Care
Focus on managing problems and complications
Labor/birth as dependent on technology
Higher rates of using interventions
Doctor delivers baby
Care is routinized

Naturally, the midwifery model describes the practice of many midwives, and the medical model describes the practice of many doctors. But many caregivers combine elements of both. It is possible, but less common, to find doctors whose practice most closely resembles the midwifery model of care and midwives whose practice most closely resembles the medical model.

Thinking about these different views can help you to understand your own values and ideas about pregnancy and birth, and can help you select a caregiver who is compatible with your needs and values. Many women have a clear preference for one or the other of these models."
Did anything in the above information describe Dell's care as seen in that minute-long birth story seem like to fit into the Midwifery Model of Care? If so, I missed it.

The thing is, I know I'm judging harshly - it's just a television show, and it's buyer beware. It's a drama, not a documentary. I get that. But to have Dell say at the end of the show:
Dell: You know what? I think I might be a pretty good midwife.

Violet: Yeah. I think you are.
really bothers me. Because that birth was not good midwifery care, in my opinion at least.

TV Guide offers some excerpts from an interview with Shonda Rimes, the executive producer of Private Practice, about the show's season two. Rimes says, "I want to find a way to make his midwifery stories interesting and compelling." I have a starting point: how about making Dell a real midwife?

So! What do you think?

Finally, here are two related posts, with lots of website & book suggestions: Choosing a Care Provider & Birth Place and Questioning Safety.

Christina @ Birthing Your Baby
Independent Childbirth Classes for Central Maine
New Mothers Support Circle
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