Midwifery care inside the hospital system and outside for homebirths has been growing! The number of home births has even risen by nearly 20%, from about 38,000 homebirths in 2019 to more than 45,000 in 2020 [1]. The benefits of midwives are finally becoming more widely recognized in America, and we need this recognition to improve access and quality of maternal health care!
But why is midwifery care rising? What are the benefits of midwives?
Evidence-Based Benefits of Midwives
With midwifery care, babies:
- Have significantly lower rates of preterm birth and low-birthweight infants [2]
- Less likely to suffer from fetal distress (abnormal fetal heart tones) and birth trauma during labor and birth.
- Less likely to require newborn resuscitation or special care in the neonatal intensive care unit (NICU).
- More likely to remain with their mothers throughout the hospital stay and be exclusively breastfed at two and four months.
Women who choose midwifery care have:
- Longer prenatal appointment times (Although, typically only if you’re outside of the hospital system)
- Lower costs for both clients and insurers [3]
- Higher rates of vaginal delivery [2]
- Lower rates of Cesareans [2]
- Reduced rates of labor induction & augmentation [3]
- Better maternal and infant health [2]
- Lower maternal and fetal mortality. This study found the states in the U.S. with the most integrated of all kinds of midwives resulted in the lowest maternal and fetal mortality [4].
- Increased satisfaction with care and experience [5]
- Improved psycho-social outcomes
- Lower rates of miscarriage [2]
- Fewer hospital admissions during the antepartum period (pregnancy).
- A lower incidence of hypertension during pregnancy and labor.
- Less need for pain medication in labor, including epidural analgesia [2]
- A lower shoulder dystocia incidence than similar women cared for by physicians.
- A lower rate of instrumental deliveries (use of forceps or vacuum extractors) [2]
- Lower incidence of retained placenta and fewer or equivalent postpartum hemorrhages.
- Fewer perineal injuries and fewer 3rd and 4th-degree lacerations.
- Reduced risk of adverse maternal outcomes [8]
If you’re interested in a low-intervention childbirth experience, check out these Evidence-Based Ways to Decrease Your Risk of a Cesarean Birth (Coming soon!)
Benefits of Midwives: Midwifery Care is Safer for Low-Risk Women
In the United States, 92-94% of pregnancies are low-risk. Some say midwifery care is safer than physician care for these low-risk mothers and babies [6]. But how could this be?
A Cochrane Review looked at 15 studies involving 17,674 mothers and babies to compare midwife-led models of care to other models of care for women during pregnancy, birth, and early parenting [2]. (This trial did not include models of care that included home birth).
The main benefits of midwives shown in this large systematic review included that women [2]:
- Were less likely to have an epidural
- Had fewer episiotomies
- Had fewer instrumental births such as forceps or a vacuum
- Were less likely to experience preterm birth
- Had increased chances of a spontaneous vaginal birth
- Were at a lower risk of losing their babies
Comparing Midwifery and Obstetrics in Low-Risk Hospital Births:
Another study compared midwifery and obstetrics in low-risk hospital births and found the mothers with midwifery care had [7]:
- 30% lower risk of cesarean birth in first-time moms
- 40% lower risk of cesarean in moms who have given birth before
The more women who have unnecessary cesareans lead to more maternal deaths for those who go on to have more pregnancies with more cesareans. Therefore, this is why it’s crucial for cesareans to be avoided unless they’re necessary. Additionally, more episiotomies lead to longer recovery times for mothers.
Furthermore, an especially compelling study showed that when the same midwives provided care for low-risk women planning home births and women planning hospital births, homebirths had fewer interventions. This study shows that if you’re low risk and desire an unmedicated, zero-intervention birth, your chances could be higher with a homebirth [8].
This study also found that women who planned a home birth were at reduced risk of obstetric interventions and adverse maternal outcomes [8].
Check out the different types of midwives there are in the U.S. in this post: How to Choose Between a Midwife and an OB-GYN?
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Sources:
[1] https://www.cdc.gov/nchs/data/nvsr/nvsr70/NVSR70-15.pdf
[2] Sandall J, Soltani H, Gates S, Shennan A, Devane D. Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database of Systematic Reviews 2016, Issue 4. Art. No.: CD004667. DOI: 10.1002/14651858.CD004667.pub5
[3] Altman MR, Murphy SM, Fitzgerald CE, Andersen HF, Daratha KB. The Cost of Nurse-Midwifery Care: Use of Interventions, Resources, and Associated Costs in the Hospital Setting. Womens Health Issues. 2017 Jul-Aug;27(4):434-440. doi: 10.1016/j.whi.2017.01.002. Epub 2017 Feb 16. PMID: 28215984.
[4] Vedam S, Stoll K, MacDorman M, et al. Mapping integration of midwives across the United States: Impact on access, equity, and outcomes. PLoS One. 2018;13(2):e0192523. Published 2018 Feb 21. doi:10.1371/journal.pone.0192523
[5] Harvey S, Rach D, Stainton MC, Jarrell J, Brant R. Evaluation of satisfaction with midwifery care. Midwifery. 2002 Dec;18(4):260-7. doi: 10.1054/midw.2002.0317. PMID: 12473441.
[7] Souter V, Nethery E, Kopas ML, Wurz H, Sitcov K, Caughey AB. Comparison of Midwifery and Obstetric Care in Low-Risk Hospital Births. Obstet Gynecol. 2019 Nov;134(5):1056-1065. doi: 10.1097/AOG.0000000000003521. PMID: 31599830.
[8] Janssen PA, Saxell L, Page LA, Klein MC, Liston RM, Lee SK. Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician [published correction appears in CMAJ. 2009 Oct 27;181(9):617]. CMAJ. 2009;181(6-7):377-383. doi:10.1503/cmaj.081869
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