Family Matters

Midwife Mania? More U.S. Babies than Ever Are Delivered by Midwives

In 2009, midwives delivered 8% of babies born in the U.S. — an all-time high. The most midwife-friendly state? New Mexico, where midwives bring 24% of all babies into the world

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In other developed nations, midwives are routinely tasked with bringing new life into the world. Not so in the U.S., where delivery is largely presided over by obstetricians. But a new study finds that midwives are getting busier, delivering 8.1% of the country’s babies in 2009 — a record high.

Slice the data differently and the proportion rises even further. Consider vaginal births only — midwives don’t do cesarean sections — and the figure rises to 12.1%, or about one of every eight deliveries, according to statistics from the U.S. Centers for Disease Control and Prevention (CDC).

“If this trend continues, it will bring us more in line with the rest of the world in giving midwives a central role in prenatal care and birth,” says study author Eugene Declercq, professor of community-health sciences at the Boston University School of Public Health. “Given that other countries have lower costs and better outcomes, it would be a positive thing for this country.”

The report, published Monday in the Journal of Midwifery & Women’s Health, analyzed two decades of CDC data that showed that a greater proportion of women are choosing to rely on midwives in what experts think is a direct reaction to rising rates of C-section births. Midwives approach birth differently than many physicians: they shy away from inducing labor in most situations, which can lead to a greater likelihood of cesarean delivery. Starting early in the prenatal period, they may take a more holistic approach, emphasizing diet. In labor, they spend much more time in the delivery room, encouraging a woman to try different positions or to walk around to get labor moving. “They have more patience,” says Declercq.

(MORE: Clash Between Midwives and Doctors Leads to Suspensions in Idaho)

A recent article in the New York Times noted that in certain chic city circles, midwives are becoming a must-have labor accessory:

“The perception of midwives has completely shifted,” said Dr. Jacques Moritz, director of the gynecology division at St. Luke’s-Roosevelt and a consulting obstetrician for three midwife practices. “It used to be just the hippies who wanted to go to midwives. Now it’s the women in the red-bottom shoes.”

And like any status symbol, a pecking order has emerged. Just as getting your toddler into the right preschool requires social maneuvering, getting into a boutique midwifery clinic has become competitive.

“We constantly have to turn women away,” said Sylvie Blaustein, the founder of Midwifery of Manhattan, a practice on West 58th Street that has its share of well-heeled clients. Opened in 2003, the practice now has six midwives on staff. “Because of the quality of care, we can only deliver about 20 babies a month.”

“It sounds bizarre,” Ms. Blaustein added, “but midwifery has become quote-unquote trendy.”

Part of that may be due to midwifery becoming more accepted by white mothers. Declercq’s study noted that in 1990, most midwife deliveries were to nonwhite mothers; by 2009, the figures had balanced out. There are also regional variations, with higher concentrations in the Northeast and West Coast. Some notable exceptions: in Georgia, midwives deliver about 18% of all vaginal births; New Mexico has the county’s highest rate, at 24% for all births. “Not surprisingly, they also have one of the lowest C-section rates in the country,” says Declercq.

(MORE: Why Most Moms Don’t Reach Their Own Breast-Feeding Goals)

In other parts of the country, some of the obstacles to expectant moms embracing midwives may stem from the confusion around their qualifications. An obstetrician is an obstetrician, but there are three categories of midwives: certified nurse midwives (CNM) are registered nurses who’ve studied an additional two years to get a degree in midwifery. Certified midwives are a small group who undergo training but come to midwifery from a background other than nursing. Certified professional midwives follow a different track altogether and attend mostly home births.

The actual number of CNM-assisted births has stayed the same over the years as the number of total births has dropped, which is why the proportion of midwife deliveries has increased. Doctors may not be too pleased with the data, since there’s long been a professional rivalry between the two camps. While in England a 1902 law put midwives in charge of maternity care, the U.S. enacted 1894 legislation in Massachusetts that made it illegal for midwives to practice without a medical license. From that point on, obstetricians have delivered most U.S. babies.

But in an article I wrote about home births, Dr. George Macones, an obstetrician at Washington University in St. Louis and chair of the American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice, singled out birthing centers as an option that more pregnant women should be able to access. Staffed by midwives, birthing centers in or near hospitals can provide a more peaceful delivery while still offering expert medical care should an emergency arise. “That’s the best of both worlds,” says Macones. “It’s a very nice, quiet, more natural experience, but if something happens you could literally be wheeled underground to the hospital.”

MORE: Scientists Decode an Unborn Baby’s DNA. Is It Cause for Celebration — or Alarm?

3 comments
goldingoddess
goldingoddess

Great news, but what a poorly written article. There isn't any information about how midwives have lower intervention and c-section rates.  Then they go on to say it is a a 'trendy' choice.  The only reason it is 'trendy' is because the access to midwife assisted birth has not been opened up to low-income populations because of politics.  Why couldn't the author have focused on that?



It is clear that the author is not familiar with midwifery from the quote below:


"Certified midwives are a small group who undergo training but come to midwifery from a background other than nursing. Certified professional midwives follow a different track altogether and attend mostly home births."


I have never heard of a 'certified midwife.'  Certified Professional Midwives are midwives that have passed the NARM requirements.  But midwifery is licensed on a State level and midwives that are licensed by their state are called Licensed Midwives.  Midwives that are unlicensed (usually because the state does not have a licensing program) are called lay midwives.  All home birth midwives that are not CNMs get their training through direct apprenticeships with other Licensed Midwives.


LAEmily
LAEmily

Hmmm....

"midwives are becoming a must-have labor accessory"

“It used to be just the hippies who wanted to go to midwives. Now it’s the women in the red-bottom shoes.”
"getting into a boutique midwifery clinic has become competitive."
"midwifery has become quote-unquote trendy.”


Yes, I very much want women to be aware of the fact that birth can exist within a paradigm where it is understood as a natural process and I believe, as a gross generalization, that the midwifery model of care does that. However, I do not want my calling to be seen as an accessory, a trend, our “boutiquey”. I want midwifery to be care that all women are aware of, and that all women have access to, because of the trust and belief in the natural process, not because it is “in”. Viewing midwifery as trendy diminishes the care that many of us feel called to, and even more diminishes the birth experiences of women! I am thrilled that women are recognizing that midwives are a safe alternative for birth companion, and I am thrilled that midwifery is reaching so many different women, but I refuse to view women’s health, women’s bodies, or birth, as trendy. 

I am not so sure this is how I want my calling/profession to be portrayed. http://sagepartera.tumblr.com/


EcoIncognito
EcoIncognito

I had a homebirth with a midwife this year and it was a terrific experience. I would recommend choosing a midwife to any healthy pregnant woman.