Originally Posted by AlexisT
Infant mortality is all deaths to one year. Not the best statistic to use for this. Perinatal mortality covers deaths to 7 days; neonatal to 28 days.
Also, in some countries, a team approach is used. Asking if a midwife attended the birth is like asking an American if an L&D nurse attended theirs. Those 100% countries still had OBs at some of the births. I'm not sure there's a consistent definition of "attendant" being used here. (Think about it--no country has a 0% CS rate, and a midwife can't perform one on her own.)
I personally emailed people in each of the countries listed above (except for the U.S.) to gather the statistics I have above on midwife attended births and many explained how their systems worked. In the countries with 100% midwife attended births, midwifery care is used 100% of the time. C-sections obviously are performed by a surgeon, but the midwife did the prenatal care and was caring for the woman when labor started and therefore would have been an integral part of the decision to move on to a c-section.
I would say that L&D nurses play an integral role the birth experiences of women in hospitals. The nurses are generally present for much more of a woman's labor than the woman's doctor is. Midwives typically are present for the majority of a woman's labor. I would venture a guess that most U.S. hospital L&D nurses do not follow the midwifery model of care either, so I think it is actually a fine thing to point out. The question is: what type of care is the woman receiving during labor? And the point here is that in the countries that make use of midwives and hence the midwifery model of care, the MMR's are much lower.
Your point about IMR is well taken, but perinatal and neonatal rates are much harder to come by for a variety of countries.