States using midwife-led maternity care have improved birth outcomes

A new study by explores the association between states with midwifery-led care, access to midwife-attended births, and childbirth-related procedures and outcomes. Some states have autonomous Midwifery laws, and do not require Certified Nurse Midwives (CNMs) to have physician supervision. In contrast, many states in the U.S have regulations requiring physician supervision or contractual practice agreements for CNMs.

Midwifery-led care is related to health, cost, and quality of care outcomes comparable or preferable to outcomes with physician-led care. Despite these findings, many U.S. states continue to rely on physician led care.* States that rely on midwife-led maternity care see improved birth outcomes:

“At a population level, women giving birth in states with regulations allowing [midwifery-led maternity care] had 13% lower odds of cesarean delivery, 13% lower odds of preterm birth, and 11% lower odds of delivering a low birth weight baby compared with women giving birth in states with more restrictive policies on midwifery practice. Although these effects were modest in magnitude, they could have important implications at the population level because there are approximately 4 million births in the U.S. each year.”

Previous studies have found that midwives are less likely than obstetricians to use interventions like labor induction and cesarean delivery that may have higher risks for women and infants when performed without definitive medical need.

What does maternity care look like in your state? Check it out here:Screen Shot 2016-03-08 at 9.56.42 AM

When midwifery-led care is available, patients tend to opt for midwifery services as an alternative to physician-led care, and are more likely to use midwifery services in their births.

The authors suggest:

it may be in states’ interests to consider or study efforts to reduce restrictions on midwifery practice to increase use of CNM services for prenatal, intranatal, and postnatal care.

Read the full study here.

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