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.

Where are the safest places in the world to give birth?

Tracy Cassels from Evolutionary Parenting recently posted on new research on the current status of maternal mortality around the world.

Where would you rather give birth – in the USA or Albania?  Most of you would probably say the USA yet your chances of survival would then be lower.  Yes, you as a mother are more likely to die from childbirth-related problems in the USA than Albania.  

Do you find this surprising? Here is the research:

New research looking at maternal mortality is out* and the findings are not good for those in the American system.  In 1990, the USA was ranked 22 in maternal health and mortality.  This year, the USA ranks 60th after dropping from 50th in the last assessment.  In fact, the US is one of only 8 countries to have seen a rise in maternal morality, up from 17.6 in 2003 to 18.5 deaths/100,000 in 2013 (the other 7 were Afghanistan, Belize, El Salvador, Guinea-Bissau, Greece, Seychelles, and the South Sudan).  In 1987 that number was 7.2/100,00 […].

Canada and New Zealand have maternal mortality rates that are half of the USA.  The UK has one that is a third.  Australia’s is a quarter of the USA’s.  Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Romania, Kuwait, Lebanon, Iran, and Serbia all have rates that are lower than that of the USA.

What can explain such high rates of maternal mortality? No, it’s not the rise in homebirth.

One of the main factors is a rise in certain diseases that make pregnancy riskier, like diabetes and hypertension.  There are also other heart and neurological diseases that are on the increase that necessitate higher-risk pregnancies.

This possible explanation leads Tracy to ask:

If most of these increases are due to increases in diseases, why are other similar, developed countries not showing the same problems?  How is all the medical technology in the world failing American mothers?  At this stage, it’s hard to know what parts actually work, but clearly the system taken together doesn’t.  Perhaps it’s the lack of integration, the lack of affordable care, or the focus on treatment instead of prevention.  Likely it’s a mix of all of it and more.


Oh – to answer the question of where you would be safest giving birth: Iceland with a maternal mortality rate of 2.4/100,000 (nearly 1/8 that of the USA).


Read the whole post here.



Image via Every Mother Counts

* Kassebaum NJ et al. Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.  The Lancet 2014; doi:10.1016/S0140-6736(14)60696-6.