In the next 60 seconds – about the same amount of time it will take to read this article – 250 babies will be born around the world. Fifteen will have birth defects. Up to six will die at birth, and a few newborns will fight to survive without their mothers, who will not live past childbirth. In the United States alone, approximately 700 women die every year as a result of either pregnancy or birth complications — a number that is going up, not down. We are currently in the same category as Afghanistan and Swaziland as countries with increasing maternal death rates.
Fortunately, a few simple resources could vastly improve the health outcomes of infants and mothers. They include clean water, adequate nutrition, basic medicine, and, in the words of UNICEF Executive Director Henrietta Fore: “A skilled pair of hands to help mothers and newborns around the time of birth.” Research has shown that some of the most skilled and effective hands around birth are those of midwives, yet shockingly few families have that option.
Currently in the U.S., only about 10 percent of births include midwives. Moreover, access to midwifery varies from state to state. A recent landmark study found that Washington had the best integration rate of midwifery, based on how well midwives were accepted by health care providers, as well as whether midwives were able to practice their full scope of skills. North Carolina had the lowest.
And regardless of region, access to midwives in the U.S. is markedly less than other industrialized countries, such as the United Kingdom, Sweden, and the Netherlands. The disparity is frustrating because in countries where midwives attend the majority of births, positive maternal and neonatal outcomes far exceed ours. The excellent proven outcomes that result from midwifery care include lower cesarean section rates, lower premature birth rates, and fewer newborn deaths. Midwives’ patients also have higher breastfeeding rates (both initiating and continuing), and lower incidence of low birth weight babies.
Midwives achieve these outcomes by forming close, respectful partnerships with expecting families during pregnancy and birth. At its essence, the midwifery model of care is based on that relationship. It supports a woman’s dignity, empowerment to make choices, and her ultimate decisions about her birth. The connection between midwife and mother leads not only to better health results, but to a better experience around birth. Studies have demonstrated women’s satisfaction with midwives caring for them, as compared to other types of obstetrical providers. That feeling of satisfaction – or lack thereof – not only is important in the critical period of pregnancy and birth, but has implications throughout a woman’s and child’s life.
So why don’t many families in the U.S. have the option of using a midwife? It’s not a simple answer. Some health insurance systems do not include midwives in their care network. Some insurance companies do not want to extend malpractice insurance to midwives because obstetrics is a very highly litigated area of medicine. Some physicians don’t want to incorporate midwives into their practice for fear that patients will leave their care for midwives.
Further, people may be deterred from pursuing midwifery because it is a demanding career with salaries that are not always commensurate with the work. And, finally, inaccuracies like “you can’t have pain medication or an epidural if you have a midwife,” and “midwives only attend births that occur at home” lead expecting parents away from looking into midwifery as an option.
Yet midwifery has endured despite a myriad of myths over the centuries. As someone who has worked in maternal and child health for over 30 years, I have lived the excellent outcomes brought about by midwifery care. I became a nurse-midwife after years working as a labor and delivery nurse because I wanted to help women achieve the births they desired. Certainly specialty high-risk maternity care would be available to every woman whose pregnancy or labor requires it, but most expecting mothers are low-risk, and I saw that they welcomed the chance to give birth in environments that encouraged a sense of normalcy rather than emergency: labor rooms that resembled their own bedrooms, freedom of movement in labor, intermittent monitoring, the ability to eat between contractions. These practices are all based in evidence, and I believe they should be standard across all births – but they are far more common with midwives.
To honor National Midwifery Week, celebrated in the U.S. from September 29 to October 5, I ask anyone starting a family to investigate for yourself the outcomes produced by midwifery care. Some good resources include Evidence Based Birth, http://www.MIDWIFE.org and birthplacelab.org.
If you want to work with a midwife, yet don’t have any included in your insurance plan, approach your health system and insurer about including midwifery care as an option.
And if you have experienced the benefits of a midwife, reach out to your legislator. Many lawmakers simply don’t know about the maternal mortality crisis in the United States, or how midwives can make a tremendous difference. Ask for legislation that supports the education of midwives and the expansion of their services.
In an ideal world, all women would have access to the maternity care provider of their choice, with midwives and physicians working collegially together. But at a bare minimum, midwives attending a birth should be as common and expected in the United States as clean water and basic medicine. Women deserve no less.
Michelle Collins, Ph.D., CNM, RN-CEFM, FACNM, FAAN is a certified nurse-midwife with over 30 years of experience in the field of maternal-child health. She is a professor in the Dept. of Women, Children and Family Nursing at Rush University College of Nursing, as well as Associate Dean of Academic Affairs at the CON.
