Family Matters

Midwives Say Birthing Centers Could Cut C-Section Rates and Save Billions

Most women still give birth in hospitals, but midwives hope to change that

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If more pregnant women delivered their babies at midwife-led birth centers, the nation’s C-section rate would go down and cost savings would go up, reversing the current twin trend of rising health care expenditures and numbers of cesarean deliveries.

That’s the conclusion reached in a study conducted by the American Association of Birth Centers and published in the Journal of Midwifery & Women’s Health. Researchers tracked 15,574 births and found that birth centers saved the health-care system $30 million in facility fees alone. Women who deliver vaginally avoid the cost of surgery and the extra time in the hospital spent recovering.

“If even 10% of births happen in birth centers, we would expect a $1 billion savings each year just in facility fees,” says Cara Osborne, a midwife who is one of the authors of the study. But for pregnant women, delivering at a birth center is still a niche practice.  It’s growing in popularity, but less than 1% of U.S. women have their babies at birth centers, in contrast to other countries where midwife deliveries are far more common.

Midwives in the U.S. are hoping to change that, with a publicity campaign called Our Moment of Truth that educates women about the benefits of giving birth in a birth center and without medications. “Women need more midwives,” says Osborne. “This sort of care should be available to all women.”

The last major study that looked at birth centers was published in 1989, when the national C-section rate was 18%. That year, women delivering at birth centers had C-sections 4% of the time; that number grew to just 6% in the current study, which relied on figures from 2007 to 2010 from 79 midwife-led birth centers in 33 states. “Midwife-led birth center births can be a way to lower national C-section rates,” says Osborne, who is also an assistant professor of nursing at the University of Arkansas.

Across the country, C-section rates have boomed. In 2010, a third of deliveries were cesarean births. With obstetricians increasingly worried about malpractice lawsuits — and some women and their doctors eager to take the element of surprise out of labor and schedule their deliveries — it’s no surprise that the number of C-sections has climbed.

(MORE: Midwife Mania? More U.S. Babies than Ever Are Delivered by Midwives)

But not only are C-sections more expensive than vaginal deliveries, they also carry a higher rate of complications for both mother and baby.

The study found that rates of emergency transfers to hospitals are less than 2% and the fetal and newborn mortality rate is less than .5 per 1,000 births, which is comparable to hospital figures for low-risk women.

It’s worth noting that the midwife-conducted study included only low-risk births; birth centers only deliver women with normal pregnancies andfew complications. About 85% of women enter pregnancy classified as low-risk, which means they have no serious medical conditions. “Doing all those extra cesareans isn’t preventing deaths,” says Osborne. “In general one of the reasons to do a C-section is to save the baby from impending doom. In fact, this tells us that many C-section births are preventable.”

In the country’s 250 birth centers, midwives tend to take far more time with patients than busy doctors do and the emphasis is on the whole woman — everything from consultations on what a woman should be eating during pregnancy to conversations about anxiety over delivery.

The midwife wellness-based model of care is “why we have such great outcomes,” says Lesley Rathbun, who owns Charleston Birth Place in S.C. “We look at pregnancy and birth as a normal physiological part of life.”

Her birth center is currently booked through July, and demand has been so constant that she is considering expanding from two birthing rooms to four. Midwives are spreading the word about their traditional way of birth in a decidedly modern way: on the Internet. “Women are consumers of health care online,” says Rathbun. “They are becoming more educated about their options.”

(MOREClash Between Midwives and Doctors Leads to Suspensions in Idaho)

A critical characteristic that sets birth centers apart from hospitals, where most women deliver, is their emphasis on a medication-free birth. The idea of not using anesthesia — epidurals are the most commonly used form of pain relief during labor — is a nonstarter for many women. “Our culture has gotten to a place where women are afraid of giving birth without anesthesia so that rules out giving birth at a birth center,” says Osborne.

Kristina Krimm, on the other hand, actively wanted to avoid anesthesia. The daughter of a midwife, Krimm compared C-section rates at hospitals and birth centers near her home in Maryland and settled on the latter. “They had such low rates of induction and C-sections and seemed to provide much more personal care during pregnancy,” says Krimm, whose experience delivering her daughter in Oct. 2011 offered a taste of both birth center and hospital delivery. Krimm’s midwife ended up suggesting she be transferred to a nearby hospital to receive an epidural when her labor didn’t progress over 22 hours. The transfer went smoothly, and her midwife stayed with her the entire time, delivering her daughter. Now pregnant with a boy due in April, Krimm plans to head back to the birth center because she was pleased with the care and found the venue to be “such a calming place”. Hopefully this time that’s where she’ll stay.

MOREWhy Home Births Are on the Rise

17 comments
V.Brent
V.Brent

And what about birthing centers IN hospitals? This "war" opposing doctors and midwives is ridiculous. Women should be allowed to give birth in less clinical surroundings, accompanied by midwives and subjected to only necessary interventions but still have access to qualified medical staff if things ever go awry.

SpartaofPhoenixAZUSA
SpartaofPhoenixAZUSA

I am against this idea of piece mail medicine. Seems to be the way to address physician shortages etc these days is to outsource specific procedures etc. Yes, midwives can play an important and meaningful ROLE in the birthing process but should work with doctors not try to purport to be something they are not...You see what is going on now with Physician Assistants trying to venture out on their own insisting their "just as good". We either have standards or we don't...

PaulM
PaulM

We waited for 5 hours for our daughter to have a natural birth in the hospital...the attending doctor kept surpressing her "rhythms" in order to have a c section and get more money....she refused several times the request for an epidural, c-section, etc. I, her father was not aware of what was going on. But after the delivery, we found out all the sh_t she had to go through...she was pissed and should have sued the damn doctor and hospital as well.  This kind of crap does not have to happen...the patient should come first and their request should be honored. Thank God and God alone the child is healthy, exceedingly happy and smart.   Her second child was born within 15 minutes or less at a  birth center. I and her mother were there...I said, Wow, that was quick. Why did it take so long at the hospital?


smr2419
smr2419

Just to add, I had a c-section and would prefer a 15 minute operation over hours of pain with the same result. I've never understood the whole "natural" birth thing. 

sophia
sophia

i agree on pregnancy and birth as a normal physiological part of life!i hope that i also will have the same way!


suastez
suastez

I've had 100% of my births at birth centers!

Gregory Kirkos
Gregory Kirkos

With more women dying in childbirth! Now that's progress!

Tamika Ann
Tamika Ann

Unless the mothers wasn't made for baby making and the baby ends up near death and the mid wife can't do anything. SO glad I was at the hospital!

Natasha Coe
Natasha Coe

I looked at a birthing center before I went to the hospital here in Portland, OR. The birthing centers do not have doctors. Midwives are well-educated, but if something went wrong, they would have to get a doctor, and that is time wasted if your baby is in need of medical care. I went to a hospital here that respected my wishes completely, and actually by normal standards I would have had a c-section, but they worked with me on that and it was prevented, I gave birth vaginally. They also had the same methods for pain management that the birthing centers had. Warm pulsating tubs. I used that, but after being in labor for 18 hours and having contractions for two days that were minutes apart, AND only being dilated to three, I really needed that epidural, hahahaha. But, I'm not knocking birthing centers, if a woman wants to give birth there. There just are things that should be considered for what you really want and what you expect, because not always is that how things are going to turn out.

EliseTelesco
EliseTelesco

Had two amazing experiences with midwives for my childrens birth. Only wish it was at home! My girls will have it that way! 

V.Brent
V.Brent

And I should know because I wanted to give birth to my daughter in a birthing center (affiliated with an hospital but not really near it) and ended up at the hospital (the midwives had an agreement with the hospital : more than 24hrs of active labor automatically led to a transfer to the hospital to minimize the risks). Everything went well (but took a really long time - it was my first child) and I wished I could have stayed at the birthing center with the added security of a doctor's supervision (which is all I ever needed anyway).

BaileyGriffin
BaileyGriffin

@SpartaofPhoenixAZUSAYou are 100% right @Crowmam. People need to realize that North America is essentially the only developed region which DOES NOT utilize midwives the way they are intended. How can the United States have some of the highest maternal and infant mortality rates for a developed country and not try to improve access to quality maternal care by whatever means possible?! OBGYN services are outlandishly expensive and do not provide the same sort of support (pre and post delivery) that midwives do... Can you really argue that countries like the Netherlands or the UK have been doing it wrong all along by using midwives as the primary care provider during labour and delivery for decades... No! Centuries! There needs to be a HUGE paradigm shift in the US. Utilizing midwives is NOT task shifting to a lesser qualified individual-- that's what's important here. 

Crowmam
Crowmam

@SpartaofPhoenixAZUSA 

Having an O.B. a trained surgeon, at all low risk births is like having a pediatric surgeon be a healthy child's babysitter.  I understand what you are saying, but Midwives are experts in getting babies out "without" surgery. 

JohnJenniferJeppson
JohnJenniferJeppson

@Gregory Kirkos, actually more women due in childbirth NOW than they did a few decades ago. And the rise in deaths are directly attributed to c-sections, because they are caused by surgical complications.