Nurse-Midwives: A Safer Alternative?

Nurse-midwives delivered 297,902 American babies in 2002, roughly 8 percent of all births, according to the American College of Nurse-Midwives. These numbers are up 117 percent from a decade ago. Though nurse-midwives are quickly gaining ground, physicians are still the primary baby catchers in the United States, even though recent studies show using a certified nurse-midwife may actually offer safer outcomes for babies, not to mention reduce the need for costly medical interventions.

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In a report published in the May 1998 edition of the Journal of Epidemiology and Community Health, researchers compared birth outcomes and infant survival for babies delivered by certified nurse-midwives with those delivered by physicians in the United States. Controlling for socioeconomic and medical risk factors, they found the infant death rate was 19 percent lower when certified nurse-midwives attended the births than when physicians did. The risk of neonatal mortality was 33 percent lower and the risk of delivering low-birth-weight infants was 31 percent lower for nurse-midwives.

“Women whose pregnancies are managed by midwives generally receive excellent care with lower rates of costly medical interventions such as Cesarean section, vacuum and forceps deliveries, induction of labor, ultrasound and continuous fetal monitoring,” the study’s authors, Marian MacDorman and Gopal Singh, wrote.

A series of studies by the Public Citizen’s Health Research Group in 2000 found that the C-section rate for hospitals with nurse-midwifery services was about 13 percent lower than the average C-section rate for all hospitals.

Studies in England have found similar results. Most of western Europe has an unbroken tradition of midwifery, with many fewer C-sections, says Carolyn Bell, a certified nurse-midwife and active member of the American College of Nurse/Midwives (ACNM). “Places that use midwives tend to use fewer C-sections.”

In Holland, pregnant women automatically see a midwife. If they want to see a doctor, they need a midwife’s referral. “And it’s not covered by insurance unless there is a medical reason,” Bell says.

So why are physician-assisted births, C-sections, epidurals and hospital births still the norm in the United States?

“A lot of what drives this country’s thinking on birth is fear. Fear of pain, so they do epidurals. Fear of being sued, so they do 20 million tests,” Bell says. “It’s safer for the provider but not necessarily for the woman.”

The C-section rate is on the rise in the United States and reached an all-time high of one-in-four in 2002, according to the National Center for Healthcare Statistics (NCHS). The ACNM issued a statement in January 2003 responding to this report that attributes the increase to a rise in elective Cesareans and the misconception that Cesarean-birth is always safer than vaginal birth.

To be a nurse-midwife, a person must first become a registered nurse, which involves pre-nursing and nursing school, and then complete a nurse-midwifery training program, says Bell, who had more than 10 years of training and attended Stanford University’s nurse-midwifery program.

Still looking for an alternative birth practitioner? Perhaps a doula is for you.