Medical Practice

2020: Entering the Year of the Midwife

By MICHELLE COLLINS, PhD, CNM, FACNM, FAAN

The World Health Organization has named 2020 the Year of the Nurse and Midwife. However, most Americans have never experienced a midwife’s care. In my over 30 years working in maternal-child health, I’ve heard plenty of reasons why. Families are understandably nervous about that with which they are unfamiliar, and nervous about pregnancy and birth in general, with good reason. The cesarean birth rate in the US has more than quadrupled since the early 1970’s, yet we aren’t seeing healthier mothers and babies as a result. In fact, compared to the prior generation, women in this country are 50% more likely to die in childbirth, and for women of color (particularly black women) that risk is three to four times higher than white women, regardless of the woman’s education level or socioeconomic status. For those expecting a baby in the new year, let me set the record straight about midwifery care.

Today’s certified nurse-midwives (CNM) and certified midwives (CM) have earned a minimum of a Master’s degree, as well as have passed a rigorous certification exam. A third category, certified professional midwives, are not required to have an academic degree, but they must also must pass a certification exam “based on demonstrated competency in specified areas of knowledge and skills.” Midwives are intensely educated both in normal, as well as in complications of, pregnancy and childbirth, and are well-prepared to address emergencies as they arise.

Midwives generally care for women with low-risk pregnancies; however, most pregnancies are low-risk. And in those instances when a patient’s pregnancy or birth becomes high-risk, the midwife collaborates with physician colleagues to provide comprehensive team care to result in the best outcome for mother and baby.

A popular misconception is that midwives only take care of women giving birth in the home. In actuality, while midwives — and even a small percentage of physicians — do care for women who give birth at home, the vast majority of births attended by midwives occur in hospitals and birth centers. Moreover, while there is an upward trend in out of hospital births, currently they comprise a very small portion of the total number of births (1.61%).

There is another prevailing misconception that giving birth with a midwife means a woman cannot have anything for pain in labor, should that be her desire. Quite the contrary: midwives honor women’s choices and preference for birth, which may include epidurals or another form of pain relief, such as nitrous oxide. More importantly, midwives use a range of tools and techniques to help women cope with childbirth, physically and psychologically. Research shows that the least-frightening birth scenarios include labor that begins naturally and progresses steadily; the ability for women in labor to move freely; the opportunity for the mother to eat and drink regularly during labor; giving birth in the position of the woman’s choice; and surgical birth only as a last resort.  Families can expect midwife-attended births to privilege all of these elements.

Probably the most harmful misconception for families is that midwives cannot provide the same quality of care as can physicians. Actually, there are absolutely no existing studies which demonstrate that the care delivered by midwives is inferior in any way to care delivered by physicians. Numerous studies, however, document  the positive outcomes of midwifery care, including lower cesarean rates, lower episiotomy rates, lower preterm birth rates, higher breastfeeding rates, fewer low birth weight babies, fewer newborn deaths, and less intervention during labor and birth. The rate of C-sections is especially important not only because of their significant expense, but because women who have surgical births are at a five times greater risk for life-threatening complications either during, or after, the surgery.

Other countries have already realized the tremendous benefits of midwives. In places that have much better outcomes in pregnancy and birth than the US, midwives are the ones providing the overwhelming majority of pregnancy and birth care. Yet the fact that only about 10 percent of births in the U.S. involve midwives – despite their lower cost – suggests that Americans are seeking some assurance they believe only physicians can provide.

The truth is, no one attending births wants women, or their families, to be afraid – after all, birth is one of the most sacred spaces in which one can be present. Families can expect midwives to bring an air of energy and competence, trust and calm to pregnancy and births. If you’re still hesitant to consider the idea of having a midwife care for you, I encourage you to get a recommendation from a friend who uses a midwife and make an appointment to meet them. I am confident that your mind will be put at ease. After all, midwives have been allaying women’s fears around childbirth for a very long time. In the Bible’s Genesis 35:17, it is written: “And it came to pass, when she was in hard labour, the midwife said unto her, ‘Fear not.’”

Michelle Collins, Ph.D., CNM, FACNM, FAAN is a Professor and Associate Dean of Academic Affairs at Rush University College of Nursing who teaches, participates in research, and actively practices as a full-scope certified nurse-midwife.

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William Palmer MD
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William Palmer MD

I delivered 43 babies in a rotating internship at LA County Hospital. My conclusion: have kids in a hospital. It’s scary. It’s bloody. Terrible things can happen like placenta praevia and fetal heart rate going way down and maternal pulmonary embolism. The person who delivers a kid should have plenty of supervised experience and lots of classroom teaching, but I don’t care who does it and midwives are fine. Read about the maternal death rates in the Middle Ages—this is why we should ascend the learning curve and have children in the safest place possible. It’s amazing to me that… Read more »

Michelle Collins
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Michelle Collins

Thank you for your response. I agree with your comment to the extent that childbirth can be scary; though it need not be. While complications can and do occur, the reality is that the majority of labors and births are low risk. Childbirth in and of itself is not pathologic; yet it is treated as such within the US health system. Much of the reason that midwives have excellent outcomes is because we view labor and birth through a lens of normality rather than pathology, recognizing it as one of the many processes in a woman’s reproductive life. This leads… Read more »