The Differences Between Technocratic and Holistic Models of Care

Robbie Davis-Floyd is a medical and cultural anthropologist who has written extensively on the differences between the hospital (technocratic) model vs. the holistic (midwifery) model of care for childbearing women.

Below is a table Robbie put together, that Anne Frye published in Volume 1 of Holistic Midwifery, that I'd like to share with you. It simply lays out the differences, as she sees them, between the technocratic (T) and holistic (H) models for women seeking care during their childbearing year.

I'm taking the time to post this because I have yet to find such an extensive, starkly honest and accurate listing. When I first read this I was both shocked and relieved to see it all on paper in one place. Of course, this list doesn't fit every doctor or midwife, but it feels fairly accurate to me. I hope you enjoy.

T: Male-centered

H: Female-centered

T: Women = objects

H: Women = subjects

T: Male body = norm

H: Female body = norm

T: Female = defective male

H: Female is normal on her own terms

T: Classifying, separating approach

H: Holistic, integrating approach

T: Mind is above & separate form body

H: Mind & body are one

T: Body = machine

H: Body = organism

T: Female body = defective machine

H: Female body = healthy organism

T: Female reproductive process dysfunctional

H: Female reproductive process healthy

T: Pregnancy & birth inherently pathological

H: Pregnancy & birth inherently healthy

T: Doctor = technician

H: Midwife = nurturer

T: Hospital = factory

H: Home = nurturing environment

T: Baby = product

H: Mother/baby inseparable unit

T: Baby grows itself through mechanical process

H: Connection between growth of baby and state of mother

T: Fetus is separate from mother

H: Baby & mother are one

T: Safety of fetus pitted against emotional needs of mother

H: Safety of baby and emotional needs of mother are the same

T: Best interested of mother and fetus antagonistic

H: Good for mother = good for baby

T: Supremacy of technology

H: Sufficiency of nature

T: Importance of science, things

H: Importance of people

T: Institution = significant social unit

H: Family = essential social unit

T: Action based on facts, measurements

H: Action based on body knowledge, intuition

T: Only technical knowledge is valid

H: Experiential & emotional knowledge valued as highly as or more than technical knowledge

T: Best prenatal care is objective, scientific

H: Best prenatal care stress subjective empathy, caring

T: Health of baby during pregnancy ensured through drugs, tests, techniques

H: Health of baby ensured through physical & emotional health of mother & her attunement to the baby

T: Labor = a mechanical process

H: Labor = a flow of experience

T: Time is important, adherence to time charts during labor is essential for safety

H: Time is irrelevant, the flow of the woman's experience is important

T: Birth must occur within 24 hours

H: Labors can be short or take several days

T: Once labor begins it should progress steadily; if it doesn't pitocin necessary

H: Labor can stop and start, following it's own rhythms

T: Some intervention is necessary in all births

H: Facilitation (proper food, effective positioning, support) is appropriate, interventions are usually inappropriate

T: Pain is unacceptable

H: Pain is acceptable

T: Analgesia & anesthesia for pain during labor

H: Mind/body integration, labor support for pain

T: Environment is not relevant

H: Environment is the key to safe birth

T: Uterus = involuntary muscle

H: Uterus = responsive part of whole woman

T: Woman is hooked up to machine with frequent exams by staff

H: Woman does what she feels is appropriate

T: Once a surgical birth always a surgical birth for most woman

H: VBAC is normal

T: VBAC = high risk

H: VBAC = low risk

T: Cesarean for breech presentation or twins

H: Squatting or hands and knees for breech, twins often born via the birth canal

T: Birth = a service medicine owns and supplies to society

H: Birth = an activity a woman does that brings new life

T: Obstetrician = supervisor, manager, skilled technician

H: Midwife = skillful guide

T: Doctor is in control

H: The midwife supports, assists

T: Responsibility belongs to the doctor and the system

H: Responsibility is the mother's