Midwives

In 1932:

The women…who were desperately poor and usually gave birth at home, were 10 times less likely to die in childbirth than the average American at the time. The nation as a whole wouldn’t catch up until the 1950s, after the widespread acceptance of antiseptic and the discovery of antibiotics.

There was nothing mystical about this improvement. The midwives simply understood that, instead of focusing narrowly on the birth, they needed healthy families to produce healthy babies. They treated snakebites, fevers and men shot in feuds. They made frequent house calls — 18 prenatal visits and 12 postpartum checkups were standard for an uncomplicated pregnancy.

More from Nathaniel Johnson in the WSJ [gated].

Comments (7)

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  1. Chris says:

    Midwives and birth centers are great if you know in advance you’ll have a complication free delivery.

    If not, you may end up with a dead baby.

    http://www.skepticalob.com/2012/04/oregon-homebirth-midwives-sued-for-50.html
    http://www.lansingstatejournal.com/article/20120320/NEWS01/303200045/DeWitt-couple-sues-birthing-center-negligence-case?odyssey=tab%7Ctopnews%7Cimg%7CFRONTPAGE&nclick_check=1

    The second link is near my house, I drive by it frequently when I go to Home Depot. Up the road the other direction we have a hospital with a fully staffed regional NICU.

    It really isn’t a hard choice for me. Do I want my child born at the place stuck between a Home Depot and a Wendy’s, across town with heavy traffic from the nearest hospital. Or do I want my child born in the hospital with a NICU in the building in case something goes wrong and my child needs emergent care?

    I understand why hippies like midwives, for the same reasons they dislike GMO food, and vaccines. They have absolutely no grounding whatsoever in science. They distrust modern science entirely, including medicine. They think earth mother gaia will take better care of their baby.

    I don’t understand why any rational person would make this choice though. Sure, the place by the Home Depot is probably cheaper, but lowering standards is not the right way to reign in healthcare costs. There are better ways.

  2. Evan Carr says:

    The demand for midwives is increasing as more women begin to desire natural births which have many health benefits for the baby and the mother.
    .
    A C-section is a major surgery with the potential for serious complication and long-term effects but is treated so casually by OBGYNs in hospitals today. In addition, typical hospital births are also accompanied by heavy use of incredibly powerful pain medicines and other medicines to induce contractions. This brings babies into the world through a mother who is not in her natural state. Also, there is some evidence that the bonding that takes place between a mother and her child immediately after birth is affected by the drugs administered during labor. And there is evidence that babies born in high-stress environments will have more agitated personalities.
    .
    Midwives today don’t just work in the house. Many work at birthing centers, which are located in close proximity to a hospital is case an emergency occurs. Others work at the hospital itself. The greatest mystery is that most if not all insurance plans refuse to remunerate for midwife-delivered births despite the fact that midwives are substantially, more than 50 percent, cheaper. Babies are also less likely to be born without abnormalities and babies delivered by midwives have a lower infant mortality rate than babies delivered by OBGYNs in hospitals.
    .
    Midwives are also easier to train since they require less school, typically a BSN (4 years) plus 2 years of practice plus a Masters in Midwifery as opposed to medical school and residency etc… Midwives are great for a lot of reasons. I believe it is time we start utilizing them more frequently for their short- and long-term benefits.

  3. MarkH says:

    Except for all the data that show that midwives have a neonatal mortality rate between 300-700% greater than that of hospital births. And that’s even considering that transfers to the hospital for fetal distress get counted in the OB/GYN deaths, and these are planned home births.

    Babies are also less likely to be born without abnormalities and babies delivered by midwives have a lower infant mortality rate than babies delivered by OBGYNs in hospitals.

    This can only believed if you engage in significant deception about how these statistics are obtained. Considering any birth defect found on prenatal screening ups the birth to higher risk – and therefore hospital only – yes hospital births have a higher rate of abnormalities. To suggest this is caused by birth in a hospital just shows you are incredibly dishonest these advocates can be. For the actual CDC statistics showing higher mortality with homebirth, or how the studies of midwives in hospitals shows they have higher mortality than OB/GYNs, even though they’re dealing with the low risk pregnangcies. From Tuteur’s summary:

    Dutch midwives have unacceptably high rates of perinatal mortality both at home and in the hospital. Indeed, the perinatal mortality rate for LOW risk women cared for by Dutch midwives is HIGHER than the perinatal mortality rate for HIGH risk women cared for by Dutch obstetricians!

    The new study, Perinatal mortality and severe morbidity in low and high risk term pregnancies in the Netherlands: prospective cohort study, appears in this week’s issue of the British Medical Journal. The authors explain that the study was undertaken to investigate why the Netherlands has highest perinatal mortality rate in Europe.

    People can do what they want, have birth any way they like, but they should not go down this path in ignorance of the data that suggests you are exposing the newborn to a greater risk of death with providers with less training, with no ability to perform surgery if necessary, or worse, at great distance from the hospital when seconds can count.

  4. Evan Carr says:

    @Chris – Midwifes are trained through institutions of higher learning. Registered midwifes are not hippie-loving medicine-women rattling sticks and applying goat feces. Just as the LSJ article points out, the problem is direct-entry midwives and certified professional midwives.

    Baylor has a program
    as does Texas Tech and a host of other Tier 1 universities around the country who require midwives to complete rigorous training before being allowed to practice.

    Midwifes receive either a CNM, CM or CPM certification. Of those both the CNM and CM require at minimum a B.S. and many require an RN and/or residency before pursuing a Master’s of Science in Nursing with a midwifery specialization, a NNP or a DNP. The CPM is definitely questionable and is most likely where a majority of problems come from.

    The articles you posted are unfortunate but do not represent the norm. Just because medicine is holistic does not mean it is crazy.

    “I understand why hippies like midwives, for the same reasons they dislike GMO food, and vaccines. They have absolutely no grounding whatsoever in science. They distrust modern science entirely, including medicine. They think earth mother gaia will take better care of their baby.” Thanks for a good laugh.

    @MarkH – your first link demonstrates exactly what I am talking about and validates my original statement. The neonatal mortality rate for Certified Nurse Practitioners is lower than MDs and home-birth midwives. CNMs and CMs are trained professionals. The original article posted by Dr. Goodman does not mention homebirths, merely the use of midwives. Transitioning away from home-births is a no brainer looking at those statistics. Bashing a profession runs counter to reason.

  5. Paula says:

    Midwives implement a modal of care that completely contrasts the modern OBGYN. An OBGYN is a trained surgeon and subsequently has little experience with the alternative birthing style most midwives provide for their patients. It is the midwives philosophy to allow for the natural progression of a birth unless otherwise instructed by the patient or required due to unforeseen complications (which are bound to occur at some point for either the OBGYN or the midwife). OBGYNs are more likely to insist on interventions to enhance the speed of the delivery. Once an intervention is implemented the chance that the patient will be put into surgery for a c-section is more likely due to the body’s natural birthing (chemical) ebb and flow being infringed upon.

    The lower cost of midwives does not signify lower quality care, but is an indicator of how little is necessary to deliver a baby. The rise of modern medicine has been helpful in securing the health of a baby and mother, yes, but it has also intervened in unnecessary ways that ultimately only create more problems, costing more money.

    This is not to say that the use of OBGYN’s in the birthing process is unnecessary; at times, their skills are undoubtedly useful and necessary. But you wouldn’t want to use a screw driver where a hammer would work better.

  6. Sadat says:

    Mid-wives and similar health profession that track the health and wellness of a group of people may be a new effective way to deliver health care and limit the traffic going through the hospitals. Certainly coordinated care is getting a lot of renewed attention, however, it seems to have mixed results.

  7. Gabriel Odom says:

    Logically speaking, anecdotal evidence hold very little real weight – other than in emotional influence and demagoguery. What brought this discussion to a head was the articles about two unfortunate occurrences concerning the dangers of midwifery. I will now offer my own anecdotal evidence:

    I am the oldest of five children. I was delivered via C-section, and my next two siblings were delivered while my mother was on a great deal of delivery drugs. She wasn’t allowed to see those two children for hours after the birth. Afterwards, she likened the entire process to being forced through a factory – and she swore off hospitals. She had my last two siblings at home, under the care of a midwife – who also happened to be a fully licensed Nurse Practitioner. I was there for my youngest sister’s birth, and it was – in a word – miraculous. The room was peaceful, and the birth went off without a hitch. The midwife met with the family, she got to know all of us, and she checked up on us weekly for a few months after the birth.
    We were not hippies – my mother simply believed that she knew more about her own body and how the baby was doing than an OB who would meet with her for five minutes or some nurses who had never seen her before.

    This being said, I certainly believe that midwives should have an RN and birthing certificates – at minimum. Personally, I would make sure to see an NP with at least a decade of experience.