Neat: first of its kind study on midwifery in the states and better birth outcomes

[IfIOnly]

I've seen similar studies and findings for other countries, but this is a first for the U.S. I live in Oregon, one of the few states mentioned with "midwifery integration." I honestly haven't seen much of that (four out of my five children were born at home with midwives), at least compared to the fabulous midwifery and hospital collaboration of other countries. Obviously there is much to be desired regarding maternal care in the U.S., but this study is hopefully a step in the right direction.  :001_wub:  

 

 

Midwife-friendly laws and regulations tend to coincide with lower rates of premature births, cesarean deliveries and newborn deaths, according to a new U.S.-wide “report card†that ranks all 50 states on the quality of their maternity care.

 

About 10 percent of U.S. births involve midwives, far behind other industrialized countries, where midwives participate in half or more of all deliveries. 

 

 

 

“A large body of cross-cultural research has actually demonstrated similar relationships between midwifery care, systems integration and improved maternity care outcomes,†Cheyney said. “This study is important because it suggests that the same relationships hold true in the United States. There are significant policy implications stemming from this work.â€

 

http://www.ktvz.com/news/midwives-linked-to-better-birth-outcomes/705726827

Edited February 22, 2018 by IfIOnly

[Lawyer&Mom]

Here is an interesting article that ranks midwifery integration by state:

 

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0192523

 

I was born in a hospital with a midwife, my first birth was in a hospital with a midwife. (Who actually became a part of the c-section team, which was pretty cool! Continuity of care!) This all seemed pretty normal to me, I didn’t realize WA state was such an outlier in midwifery integration compared to the national norm.

[IfIOnly]

Here is an interesting article that ranks midwifery integration by state:

 

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0192523

 

I was born in a hospital with a midwife, my first birth was in a hospital with a midwife. (Who actually became a part of the c-section team, which was pretty cool! Continuity of care!) This all seemed pretty normal to me, I didn’t realize WA state was such an outlier in midwifery integration compared to the national norm.

 

Great link!

 

That's wonderful you've had that experience. We've had midwives employed by our local hospital come and go. The times when I wanted to give birth in the hospital with a MW, there were not none available at the time. Frustrating.  Though, I've always been located as such that I was no greater than the recommended 10 minutes or less from the hospital with my home births. More like 5 min. actually. I'm sure this made my home birth decision much easier to make.

Edited February 22, 2018 by IfIOnly

[Sandwalker]

I work at a hospital in which midwives deliver most of the babies. We have a relatively low c section rate, and very very low episiotomy rate.

[Farrar]

It makes me sad that midwifery care isn't available to more people. Birth options in the US are so lacking.

[LarlaB]

What a cool study!

 

My 2nd delivery was in VA with a midwife in a medical center (in a birthing tub and I pulled DS out). Fantastic pre and post natal care as well as delivery! I LOVE midwives and doulas and wish it was more widely accepted practice...

[Happy2BaMom]

I work at a hospital in which midwives deliver most of the babies. We have a relatively low c section rate, and very very low episiotomy rate.

 

Had a midwife for both of my kid's births. Had two different ones as we had moved in between first & second. My first midwife, who had delivered >2,500 babies, had a episiotomy rate (for her patients) of 2%. Her C-Section rate was something like 4% (she didn't perform the C-Sections, obviously, and obviously she dealt with low-risk patients, but it's still darn impressive). 

 

I didn't have an episiotomy with either kid. One was 8.5 lbs and one was a shade under 8. I had a 2-stitch tear (I forget what the classification system is - I had the lowest level) with the first and no tears or stitches with the 2nd. And I did not have one single instance of incontinence after the birth of either child. Or any sexual dysfunction, or any of the other things they warn mothers about. I believe the rates are dropping and general awareness is higher. But it's still taken far longer than it should have and some doctors still routinely give them. 

[FaithManor]

First birth, attended by a male obgyn with a bad, bad attitude. Terrible experience.

 

All three boys, CNM at the hospital. Unbelievable level of care. The last one was really high risk, but the OB new I needed my CNM for the support and he stayed in the shadows, consulting as necessary.

 

I loved the best of both worlds. The technology and life saving aspects of the hospital, but all of the personal care and attentiveness of the CNM. In my case, birth sites were private, very homey, and comfortable. I realize it is not like that everywhere.

 

My CNM’s has a very, very low rate of c-sections and significant labor and birth interventions. I am glad they are studying this.

[cuckoomamma]

My midwife is one of the authors!!! How cool :)

[IfIOnly]

First birth, attended by a male obgyn with a bad, bad attitude. Terrible experience.

 

All three boys, CNM at the hospital. Unbelievable level of care. The last one was really high risk, but the OB new I needed my CNM for the support and he stayed in the shadows, consulting as necessary.

 

I loved the best of both worlds. The technology and life saving aspects of the hospital, but all of the personal care and attentiveness of the CNM. In my case, birth sites were private, very homey, and comfortable. I realize it is not like that everywhere.

 

My CNM’s has a very, very low rate of c-sections and significant labor and birth interventions. I am glad they are studying this.

 

Wow, that is wonderful!  I just wish this model of care was not a unicorn for most women in the U.S.

[IfIOnly]

My midwife is one of the authors!!! How cool :)

 

Very cool!   :thumbup:

[gardenmom5]

I'd send this to my dd, but I think she'd be displeased with me. .. . .

 

I'd like to also add - the nurses on the floor make a big difference too.   I had one hospital with very good experiences (three different drs for three different babies.  one had a very bad attitude.  the best was a female obgyn.)

and another hospital where I was ok with the doc - but my experiences with some of the nurses were atrocious. one nurse I ended up reporting -  she left my arm so covered in bruises, a subsequent nurse thought my husband was physically violent with me.

[Carol in Cal.]

I did not have a midwife; out here at the time they were uncommon in hospital settings and mostly known for trying to talk you out of drugs.  I looked for a doula but was unable to find one.  Luckily I got very fortunate with my nurse.

[happypamama]

I loved my midwives, all of them.  I used them for five and a half pregnancies, and five births -- one in a freestanding birth center and four at home.  I loved that they handled minor complications without turning them into big emergencies unnecessarily.  I wish all women had access to competent, knowledgeable, skilled midwives.

 

However, in all fairness, I love my MFMs too.  I don't know how they and their OBs are for an uncomplicated birth though, but they rank pretty highly on my list for patient satisfaction when things go badly.

[IfIOnly]

I did not have a midwife; out here at the time they were uncommon in hospital settings and mostly known for trying to talk you out of drugs.  I looked for a doula but was unable to find one.  Luckily I got very fortunate with my nurse.

 

Women who want the emotional support and help with drug free comfort and pain measures during labor and birth are generally attracted to a MW. I do wonder about how a midwifes role works in an elected epidural birth. Surely, these women in countries with 50% or so midwife supported births aren't opting to go drug free. I know my midwives have always mentioned they would 100% support me changing my mind during labor and opting for hospital and medicated birth. They get paid for the full birth fee, even in the event of transport. :)  I believe a MW should inform a client of the risks and inform of research, but put no pressure either way. I know there are def. things that support a safer birth with an epidural, like no not medically necessary induction, laboring through early contractions as much as possible, side lying vs on the back, no pitocin, and more.

[Carrie12345]

I'm surprised it's only 10%, but I suppose my perception is skewed because of my social circles, lol.

 

I had my first and second babies with OBs, but a MW popped into my room during my labor with the second. She gave me a couple of suggestions in about 5 minutes, and I was sold for life! 3, 4, and 5 were born with midwives.

 

#4's birth did turn scary.  I was evicted from the tub and my MW had the OR prep for a c-section. But while they were prepping, she helped me get that baby out!  I am so glad that obstetrics exists, and that it was available in an emergency, but also that my MW was able to help me avoid needing it.

 

I did have to argue with them to induce me with #5. They were parting with my hospital the week of my due date, I didn't want to be almost 2 hours away from their new "home", in winter, with a fifth delivery, and there were no other well-reviewed options in the area at the time.  My birthing history and my pros and cons list screamed "Do it!" So, yeah, it can be difficult to talk some MWs into interventions, but I pushed the my baby/my body/my birth/my informed choice routine on them.  ;)   Ds and I were discharged on their last day of hospital privileges there.

 

My favorite thing about not having any more babies is not having to look for midwives that can stack up to the ones I had.

[Sandwalker]

Birthing was taken from midwives years ago, and male doctors began delivering babies. There is a lot of money in maternity care and birthing.

[eternalsummer]

my first child was delivered by a midwife (a CNM in a hospital, who also had a JD of all things), and it was great.  I've had midwives for prenatal care since then but not been delivered by one.

 

I have to say, though, the nurse in a hospital delivery makes a much bigger difference, for me, than the ob-gyn or midwife.  After my first baby I've not had a labor longer than a few hours, generally significantly shorter, so it's not like the doctor ever shows up before it is basically time to catch the baby anyway (and out of 6 births, I think only 2 were delivered by the doctor/midwife who intended to deliver - the rest were just "find someone on the floor now who can come catch this baby!" and the ob-gyn shows up 20 minutes later).  I've had some great nurses and some terrible nurses, of course.  

[Laura Corin]

my first child was delivered by a midwife (a CNM in a hospital, who also had a JD of all things), and it was great.  I've had midwives for prenatal care since then but not been delivered by one.

 

I have to say, though, the nurse in a hospital delivery makes a much bigger difference, for me, than the ob-gyn or midwife.  After my first baby I've not had a labor longer than a few hours, generally significantly shorter, so it's not like the doctor ever shows up before it is basically time to catch the baby anyway (and out of 6 births, I think only 2 were delivered by the doctor/midwife who intended to deliver - the rest were just "find someone on the floor now who can come catch this baby!" and the ob-gyn shows up 20 minutes later).  I've had some great nurses and some terrible nurses, of course.  

 

In the UK, it's the midwives that are following the woman in labour through the entire process.  Depending on shift changes, it may not be the person you expected who will manage the actual delivery, but it's the midwife team who run the show.  With my first who was born in London, I only saw a doctor when it came to stitching - some midwives are trained to stitch but it so happened that the one on duty was not.

 

In Hong Kong, it was a midwife who was with me through labour but (under Hong Kong rules) they are not allowed to manage the actual birth, so my OB turned up at the last minute.

 

[fralala]

It makes me sad that midwifery care isn't available to more people. Birth options in the US are so lacking.

 

Not only this, but it infuriates me that poor people, and especially African Americans, who have a rich tradition of midwifery based upon necessity (and with whom modern ob/gyn has a sordid history), apparently now are the ones who are benefiting least from this kind of integrated care. And it makes me sad that less than 5% of CNMs are African American (although I realize that not all midwives are CNMs, these are the ones that are performing births in the hospitals where I've delivered babies, and who are transforming care there).

[Bluegoat]

There was a similar study for low risk births done at our women's hospital between OB and GP deliveries, which found that the GPs had better stats.  I think the connection is similar - the GPs see fewer extreme cases and so they tend to treat according to what is normal or statistically likely, whereas the OBs seem to work on a worst case scenario kind of basis.  

[SparklyUnicorn]

I had midwives for both kids.  The practice I went to had 5 midwives and 5 doctors.  The doctors show up about 5 minutes before the baby is born because I guess by law they must be present at the birth, but otherwise the midwives did everything else.  I love how they spend a lot of time with you. 

 

When my water broke with my first kid they admitted me the day after and induced me.  It took three days for him to be born.  No doctor would have waited that long.  I really think it was in large part because midwives are much less likely to rush things along (so long as there is no indication of issues). 

[Dmmetler]

My OB’s partners are CNMs, and while I was too high risk for a CNM delivery (I have to be a C section due to having a vertical incision and too much damage to VBAC),she handled almost all the monitoring for my PE-for awhile, I was talking to her daily about blood pressure, protein levels, and just how I felt. I think it made a major difference in keeping my stress level low and a lot of that was the type of care a midwife (and a MW focused practice) does. My OB is one of the only ones that speaks Spanish in the area, and many of his patients come from countries where midwives are the standard and are much more comfortable with that, so he created the practice that was hard to find here.

 

I don’t know if the outcome of my first pregnancy would have been better had I been with that practice from the start, but I strongly suspect it might have made a difference. At very least, I probably would have been more comfortable calling them with questions, because the midwives spend a lot more time talking to you and don’t make you feel like your questions are a nuisance.

 

And, on the other side, when I started having perimenopausal issues and hormone swings, he immediately sent me to one of his partners, who suggested some teas and foods that would likely help stabilize things :).

 

FWIW, I think the same applies in other areas of medicine. My Endocrinology practice includes two nurse practitioners (one with a PhD and a specialty in endocrine issues in women of reproductive age) and two MD’s. The nurse practitioners spend far more time talking with you and finding out how you feel and what is affecting you, and adjust medication more based on how you feel than on the numbers. The MD’s will tell you that with the numbers where they are, you should not be still having symptoms. DH has the same experience at his urology office. The nurse practitioner listens more and just plain is more understanding, and bases care around the patient, not just the test results.

 

And, do I have to mention that my insurance company pays about 1/3 less for an appointment with a nurse practitioner, even one with a PhD, that they do for an MD?

[bluemongoose]

All 4 of my children were delivered in the hospital with a cnm. 2 were higher risk pregnancies, one for sure would have ended in a cs if I had had an ob. My experience was not always the best...because the delivery itself was hard...but the cnm listened and encouraged and made it the best possible outcome. I love the integrated system that allowed me to have a cnm but also allowed for the backup ob team in case I needed it. I never did, but it eased my mind to know I was in a hospital and they were nearby, especially since I was high risk. It also eased my mind to have a cnm who knew me well and would be my advocate with the ob if it was warranted. My cousin had the same midwife and she had a cs and the midwife attended during the cs.

[Lawyer&Mom]

Great link!

 

That's wonderful you've had that experience. We've had midwives employed by our local hospital come and go. The times when I wanted to give birth in the hospital with a MW, there were not none available at the time. Frustrating. Though, I've always been located as such that I was no greater than the recommended 10 minutes or less from the hospital with my home births. More like 5 min. actually. I'm sure this made my home birth decision much easier to make.

The midwives at our hospital have a group practice, seven CNMs, one for each day of the week... So you don’t know who will be on call when you go into labor, and you can have a shift change, which I did, but they are all great, so it really doesn’t matter. But we are *so* spoiled here in Seattle. The OBs at our hospital are also fantastic, super patient focused. My second pregnancy I was not a candidate for a VBAC so I just went straight OBGYN, and they were really wonderful too.

[Bluegoat]

On another note - I'm glad to see this getting researched.  I have a friend who is really into the so-called skeptic community and posts things from a website which says it promotes science-based medicine.  Some of it's stuff is fairly solid, like on homeopathy, but that's pretty low-hanging fruit.  I couldn't take much they said seriously after  read their section on midwifery care, which they seemed to think was old ladies in sandals with a warm towel.

 

So much for an empirical basis.

 

The more research to point to the better.

Edited February 23, 2018 by Bluegoat

[Garga]

I had midwives at both my births.  I loved having a midwife.  

 

I remember for the first one, she delivered at two different hospitals and I could choose which one I wanted to use.  I went to one of the hospitals to tour the maternity ward with a group of expectant parents.  When the nurses were showing us all the things the use in the birthing room, they asked us who our OBs were.  When I said mine was the midwife, their eyes lit up and when they showed us certain things like continuous fetal monitoring devices they'd say, "These are what your OB will use to monitor the baby...well, unless you're Ms. Garga here and she won't have to worry about that since she has a midwife."  They said that about a lot of things and spun it as a good thing that the person with the midwife wouldn't have to be subject to all the intervention items the OBs would use.  I have no idea what was going through the heads of the other parents on the tour.  Either, "I wish I had a midwife!' or "Thank goodness I'm not going to a midwife who won't even bother to monitor my baby!"

 

For my first pregnancy, every single office appointment lasted at least an hour while the midwife talked over everything with me.  Everything.  It was glorious.  

 

For my second pregnancy I knew more, plus I had moved.  The midwife was the only one in the area so she had more clients and didn't have as much time to spend with me...but it was ok because I didn't feel that I needed the long visits.  By then, I had a hyper 2 year old with me at appointments and wanted them to be done fast.  She delivered out of a hospital and said that all of the nurses in the hospital that had ever worked on the OB floor and became pregnant, had come to her instead of an OB.  I figure the OB nurses know who the best providers are for childbirth.  

 

 

And I also had wonderful nurses when I was laboring.  One made a point to come by the next day and tell me what a great job I'd done and give me a hug.  The other patiently held my hand for the longest time when I needed her to.  

Edited February 23, 2018 by Garga

[LMD]

I had my babies through public hospital midwifery programs. I didn't pay a cent. These options are only available for low risk pregnancies.

 

My first two children were born at one hospital which had a birth centre run by midwives, you were looked after by a team of midwives according to who was on shift. The birth centre had access to the gas as a pain relief option. With my first birth, I had to be transferred to the non-midwife labour ward due to complications - needing an induction. The midwives fought for me to come back after my straightforward birth, because the birth centre had private rooms!

I had post-birth complications with #2 (same birth centre) and was rushed to theatre - a positive of in-hospital midwife birth centres - and again the midwives fought for me to come back after the spinal tap wore off.

 

For #s 3 & 4, I used a different midwifery program through a different hospital. This. Was. Amazing! It was a caseload midwife program, which means that you are assigned to a midwife who you see for every single appointment and who does her best to be at your birth. The could deliver at the hospital or at home (I did one of each). If you delivered in hospital you had access to the gas pain relief, but not at home. I loved my midwives, we built up a great rapport, we trusted each other so I felt really supported. Best option ever!

[StaceyinLA]

Wow, that is wonderful! I just wish this model of care was not a unicorn for most women in the U.S.

I wish the same. However, I think the sad thing is, women in the U.S. are so used to having everything yesterday, many want those unnecessary inductions, which, in turn, leads to so many more interventions (and poorer outcomes).

 

It’s not just the attitudes of the medical professionals that needs to change, but the attitudes of 90% of the women giving birth.

[kiwik]

In NZ midwifes handle nearly all births. After 12 weeks pregnancy you GP is not funded for pregnancy matters and you are switched to a midwife. Honestly i don't really like it. I understand that pregnanxy is not a sickness but nor is it independant of your general health. I would have hoped my GP wouldn't have prescribed me a lactation drug known to cause depression at the same time as prescribing anti depressants for example. As it happens neither of my babies were delivered by my midwife - one was a C section (the baby was handed to the midwife though) and one was born when my main midwife was unavailable and my backup one on leave.