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.

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