Midwife Attended Birth Statistics by Country

[Jaimee]

I'm doing a little presentation to a college class about birth options.  Many of these students will have never considered a midwife a viable option before and I would like to enlighten them about midwives around the world (specifically developed countries like Europe, Japan, Australia, etc.) and how these statistics relate to maternal mortality rates and infant mortality rates.  I have found fairly current MMR and IMR rates by country, but I am having a very hard time finding the percentage of births attended by midwives in other countries.  So far I've only found the US, Canada, Sweden, the Netherlands, and Denmark.  Does anyone know where I can get more stats?

Thank you!

Jaimee

[rara921]

Did you end up finding the percentage of births attended by midwives for developed countries?  I'm trying to find that data myself...sorry I can't help you...

[Jaimee]

I did hear back from several countries that I emailed directly.  Here's what I have so far:

Country (MMR rank)                                      MMR                                  IMR     % births attended by midwives

Sweden #2	4.6	2.74	100
Austria #5	5.5	4.37	100
Israel #8	5.9	4.17	70
Canada #9	6.6	4.99	6.1
Spain #10	6.7	3.42	70
Finland #17	7.2	3.45	75
Switzerland #19	7.4	4.12	99
Netherlands #20	7.6	4.66	70
Norway #21	7.6	3.55	70
United Kingdom #23	8.2	4.69	70
New Zealand #25	8.5	4.85	99
Denmark #28	9.4	4.29	100
United States #39	16.7	6.14	8

I made a graph out of these data as well and it's pretty impressive how you can see the lower MMR and IMR in the countries with higher rates of miwife attendance.  Except for Canada!  Perhaps it's socialized health care that does it.  :)

[rara921]

Oh awesome!  who did you email for the stats?  I used the World Bank data statistics for IMR and MMR rates and I also found the ratio of nurse/midwives per 100,000 people: 

Nurse/Midwife Density per 10,000 Population
Developed Nation	Ratio
Norway	163
Ireland	158
Netherlands	151
Sweden	116
Switzerland	110
Australia	109
Iceland	101
Canada	100
US	98
Denmark	98
Japan	95
Finland	89
New Zealand	87
France	81
Germany	80
Spain	74
Israel	61
South Korea	44
Belgium	5
Liechtenstein	N/A
Table 4. Nurse/Midwife Density for 2000-2009 per 10,000 Population for the 2010 Top Twenty Developed Nations in Descending Order. The density of nursing and midwifery personnel is the number of nurses/midwives per 10,000 population. From labour-force and employment surveys, health-facility assessments, and routine administrative information systems.

this is for years 2000-2009.

[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.)

[Jaimee]

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. 

[MujerMamaMismo]

The point about 100% midwife attendance at birth is certainly valid in an Australian context. All births here are attended by midwives, as opposed to L&D nurses but that certainly doesn't mean all those midwives are philosophically aligned with the midwifery model or natural / low intervention birth - many more work more to an obstetric model of care, than don't. Without investigating the accompanying intervention rates, I don't think you can get a true idea of a country's birth culture. Australia has a very high c-section rate. 33% overall but up to 65% in some private hospitals. And more broadly, our intervention rate is out of control - with some figures suggesting as high as 95%.

ETA: your table was all skewed on my screen and now that I understand it better and have read properly over the post, I take your point - your interest is in morbidity rates. I'll leave my post here nonetheless in case it's interesting to you.

[Jaimee]

Originally Posted by MujerMamaMismo 

The point about 100% midwife attendance at birth is certainly valid in an Australian context. All births here are attended by midwives, as opposed to L&D nurses but that certainly doesn't mean all those midwives are philosophically aligned with the midwifery model or natural / low intervention birth - many more work more to an obstetric model of care, than don't.

Interesting, certainly.  I am surprised that midwives are trained in the techno medical model in Australia.  Incidentally Australia didn't write me back.

Rara921: I emailed contacts at each country's midwife association(s) via the International Confederation of Midwives.

[jvalencia]

Jaimee,

I'm wonding if I could post your graph into my blog?

Thanks in advance.

[mothercat]

Have you looked at the State of the World's Midwifery by the UNFPA. Excellent report.  Here is the main page: http://www.unfpa.org/sowmy/resources/en/main.htm.

I think Safer Midwifery for Michigan used this report and distilled it into a chart that may have all the info you are looking for. It's either the first or second in their series about midwifery education.

Also keep in mind that in some countries such as Greece, that although they have  certified nurse-midwives attending births, they actually function as L&D nurse, not independent midwives.

In discussing  midwife attended birth, please be careful when comparing their educational background. Throughout the world midwives are educated at a university level, not self study and apprenticeship.