Relationship-Based Care December 21, 2010

Relationship-based care is the essence of midwifery. It is the way midwifery has been practiced since the vocation existed. What is it exactly, and what does that mean for client care?

The typical obstetric model in this country is not relationship-based, and it really can’t be. For most women, the typical scenario is this: she (and her partner, if applicable) meet with an obstetrician to interview him/her. Once they hire the obstetrician, prenatal care begins. In a group practice, the appointments will be rotated so that the woman/couple get to meet as many of the practice’s providers as possible. Usually, the “face-time” spent with the obstetrician is 10-15 minutes per appointment. This is important, because the providers rotate their “on-call” schedule, and this way the woman gets to meet the different doctors who may be attending her birth. When she arrives at the hospital, the nurses provide much of the care with the doctor checking in with them and being there to deliver the baby. If the hospital is a teaching hospital, then the doctor may be supervising a resident who will attend the birth.

In this scenario, it just isn’t possible to develop a primary relationship with anyone in the practice, and even if that were to happen prenatally there is no way to guarantee that provider will be at the birth (unless they are induced or choose an elective Cesarian section, which is a whole other topic).

When receiving care in a midwifery practice that uses the relationship-based model, the scenario is different. After interviewing a midwife and choosing to hire her, the woman is assigned a two or three-person birth team. The midwifery team attend the prenatal appointments, are on call for the birth, and attend the six weeks of postpartum visits. Each of the visits last at least an hour. By the time of the birth, the client and her midwives have developed a relationship that can have an important function in her care. If the partner has had an opportunity to develop a relationship with the midwives, this can play an even more important role.

One of my favorite stories of a partner at a birth is as follows: a trio of midwives was attending a home birth for a first-time mom. The labor was progressing quickly, and the mama was in the tub making beautifully strong and loud labor sounds. Her partner later told them that he was a bit concerned in that moment, and had looked across the room at one of the midwives for reassurance. He said that they looked almost bored. He knew that they weren’t actually bored (and they weren’t!) but were calm and unruffled by the intensity of the labor sounds. I often think of that story and think of how different his reaction could have been if he hadn’t attended all the prenatal visits and come to build a relationship of his own with the midwives on his team. If someone who had only met them a couple of times had looked across the tub and thought they looked bored, would that have been as reassuring as it was for him? Or would it have been alarming and worrisome?

Like any relationship, the relationship between clients and midwives takes time to grow, and is going to be different every time. Some relationships will work better than others; some midwives and clients will be more successful and building a trust relationship than others, and it will almost never be an instant relationship. But when it does happen, it is always worth it! Having a mutually trusting relationship has been shown to improve health care outcomes.

If you want to read more about relationship-based care, check out:

http://www.chcm.com/services/RBC/rbc.asp

or

http://www.amazon.com/Relationship-Based-Care-Model-Transforming-Practice/dp/1886624194

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