The United States does not have the best track record when it comes to safe birthing. Recent news reports have highlighted the fact that the US has the worst rate of maternal deaths in the developed world, and sadly is on the rise. Infant death rates are also very high. In fact, you'd be better off birthing your baby in Albania, Bulgaria, or Iran, all countries with better maternal and infant outcomes.
Not one European country has higher perinatal mortality rates than the United States, a region where 75% of births are attended by midwives. In comparison, only 8% of US births are attended by midwives. While certified nurse midwives (CNM) are licensed in all 50 states, thier scope of practice in a hospital is limited by the often-medicalized physicians under which they serve.
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Researchers from the University of Massachusetts Amherst and the University of Minnesota School of Public Health conducted a hospital-level analysis that revealed that women who birthed their babies at hospitals that had a more significant percentage of midwife-attended births were less likely face episiotomies or cesarean deliveries.
The analysis examined the experience of individual women who birthed at 126 hospitals across New York state in 2014, specifically looking at four outcomes among low-risk women: labor induction, cesarean birth, episiotomy, and severe maternal morbidity.
Approximately 25% of the hospitals in the analysis had no midwives present. Half of the hospitals had midwives on staff, but they attended less than 15 percent of the births. Only 7% of the hospitals had midwives that participated in 40 percent of births.
The analysis found that women who gave birth at hospitals with more midwife-attended births had lower odds of giving birth by cesarean and lower odds of requiring an episiotomy. Labor induction rates and maternal morbidity were not affected by the percentage of midwife-attended births.
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The authors note that more midwife-attended births may be associated with fewer obstetric interventions, and thus, lower costs. Previous studies have demonstrated that midwives are more cost-effective than obstetricians in low-risk obstetrical patients.
"I hope that this work contributes to the evidence related to promoting the quality and value in maternity care that midwives can bring. A number of studies have shown that expanding their scope of practice and giving midwives more autonomy can increase women's access to midwifery care," said Dr. Laura Attanasio in a press release.