SCIENTIFIC AMERICAN REPORT: The U.S. Needs More Midwives for Better Maternity Care

For better birth outcomes, the U.S. should rethink maternity care

By THE EDITORS | Scientific American February 2019 Issue

(Please read full article at Scientific American:

Art by Ramona Ring for Scientific American. Go to

Art by Ramona Ring for Scientific American. Go to

Despite the astronomical sums that the U.S. spends on maternity care, mortality rates for women and infants are significantly higher in America than in other wealthy countries. And because of a shortage of hospitals and ob-gyns, especially in rural areas, many women struggle to access proper care during pregnancy. Moreover, the rate of cesarean sections is exceedingly high at 32 percent—the World Health Organization considers the ideal rate to be around 10 percent—and 13 percent of women report feeling pressured by their providers to have the procedure

Widespread adoption of midwife-directed care could alleviate all these problems. In many other developed countries, such as the U.K., France and Australia, midwifery is at least as common as care by obstetricians. In the U.S., certified midwives and nurse-midwives must hold a graduate degree from an institution accredited by the American College of Nurse-Midwives, and certified professional midwives must undergo at least two years of intensive training. This is designed to make midwives experts in normal physiological pregnancy and birth. Thus, for women with low-risk pregnancies who wish to deliver vaginally, it often makes sense to employ a midwife rather than a more costly surgeon. Yet only about 8 percent of U.S. births are attended by midwives.

The roots of America's aversion to midwifery go back to the late 1800s, when the advent of germ theory and anesthesia reduced much of the danger and discomfort associated with childbirth. The benefits of these technologies brought doctors to the forefront of maternity care and pushed midwives aside. Obstetricians helped to bar midwives from practicing in hospitals, which were now considered the safest birth settings. By the early 1960s midwifery was virtually obsolete.

It has made a comeback since then, with practitioners just as well trained as doctors to supervise uncomplicated deliveries. Studies show that midwife-attended births are as safe as physician-attended ones, and they are associated with lower rates of C-sections and other interventions that can be costly, risky and disruptive to the labor process. But midwifery still remains on the margins of maternity care in the U.S.

To bring it back into the mainstream, midwives must be fully integrated into the medical system. Some states currently refuse to recognize them as legitimate practitioners, and some severely limit what midwives are allowed to do, despite evidence that states with the most restrictive policies also have some of the highest rates of adverse birth outcomes, such as deaths of newborns. If midwives were allowed to work alongside other providers, patients would get the care advantages, and if difficulties arose, a woman whose home birth suddenly became complicated could be seamlessly transferred to a hospital. . . .

Please read full article at Scientific American: