The Proof: Research
In countries where midwives are integrated into the health care system, the benefits of midwifery care are well-documented. Global health experts recommend scaling up midwifery to improve maternal and newborn outcomes, reduce rates of unnecessary interventions, and realize cost savings. Midwifery care in the United States (US) is markedly lower than in most other (OECD) countries, with approximately 10% of US births attended by midwives compared to 50–75% in other high-resource countries.
- Saraswathi Vedam,
Integration of Midwives
It is becoming clearer and clearer through research: greater access to community midwives can significantly improve maternal and infant health. Below are excerpts from published articles and studies that examine these correlations and see just what community midwives can do.
“Now a groundbreaking study, the first systematic look at what midwives can and can’t do in the states where they practice, offers new evidence that empowering them could significantly boost maternal and infant health. The five-year effort by researchers in Canada and the U.S. ... found that states that have done the most to integrate midwives into their health care systems, including Washington, New Mexico and Oregon, have some of the best outcomes for mothers and babies. Conversely, states with some of the most restrictive midwife laws and practices — including Alabama, Ohio and Mississippi — tend to do significantly worse on key indicators of maternal and neonatal well-being.
“We have been able to establish that midwifery care is strongly associated with lower interventions, cost-effectiveness and improved outcomes,” said lead researcher Saraswathi Vedam,” 1
““In communities that are most at risk for adverse outcomes, increased access to midwives who can work as part of the health care system may improve both outcomes and the mothers’ experience,” Vedam said.
That’s because of the midwifery model, which emphasizes community-based care, close relationships between providers and patients, prenatal and postpartum wellness, and avoiding unnecessary interventions that can spiral into dangerous complications, said Jennie Joseph, a British-trained midwife who runs Commonsense Childbirth, a Florida birthing center and maternal care nonprofit. “It’s a model that somewhat mitigates the impact of any systemic racial bias. You listen. You’re compassionate. There’s such a depth of racism that’s intermingled with [medical] systems. If you’re practicing in [the midwifery] model you’re mitigating this without even realizing it.”” 1
“The benefits of midwifery come as no surprise to maternal health advocates. In 2014, the medical journal Lancet concluded that integrating midwives into health care systems could prevent more than 80 percent of maternal and newborn deaths worldwide — in low-resource countries that lack doctors and hospitals, by filling dangerous gaps in obstetric services; in high-resource countries, by preventing overuse of medical technologies such as unnecessary C-sections that can lead to severe complications. A review by the Cochrane group, an international consortium that examines research to establish best practices in medical care, found that midwives are associated with lower rates of episiotomies, births involving instruments such as forceps and miscarriages.” 1
“In our state-by-state comparison, however, the best outcomes for mothers and babies occur in states where all types of midwives are regulated and integrated into the health care system regardless of birth setting.” 2
“Higher MISS (Midwifery Integration Scoring Systems) Scores were associated with significantly more access to midwives, significantly higher rates of physiologic birth outcomes, lower rates of obstetric interventions, and fewer adverse neonatal outcomes. … Our findings can inform health policy to improve regional access to high quality maternity care across populations and birth settings” 2
“For women in the United States with low-risk pregnancies, birth centers can offer an alternative to the typically expensive and intervention-heavy maternity care system. Birth centers don’t do cesarean deliveries, but among women in birth center care, about 6 percent of them end up with a C-section after transferring to a hospital; that’s far lower than the 26 percent of low-risk pregnancies over all that are delivered by C-section. Plus, the costof a birth center delivery is roughly half that of an uncomplicated hospital birth (often paid for by insurers, including Medicaid).” 3
“While some studies suggest a small but significant increase in neonatal death and adverse outcomes, the majority of studies across a variety of countries have shown no increase in neonatal morbidity and mortality for planned home birth. Additionally, maternal outcomes are consistently better for planned home birth, including less intervention and fewer complications. Satisfaction with the birth experience is also high in the home birth setting.” 4
Martin, Nina. “A Larger Role for Midwives Could Improve Deficient U.S. Care for Mothers and Babies.” ProPublica, 9 Mar. 2019, www.propublica.org/article/midwives-study-maternal-neonatal-care?fbclid=IwAR1Sy-dR1nx2XBKFwwdMdSK7q4JNkitZw9g9FGNra3EU-nsNikV_weZDwFY.
Vedam S, Stoll K, MacDorman M, Declercq E, Cramer R, Cheyney M, et al. (2018) Mapping integration of midwives across the United States: Impact on access, equity, and outcomes. PLoS ONE 13(2): e0192523. 10.1371/journal.pone.0192523
Callahan, Alice. “Should You Give Birth at a Birth Center?” The New York Times, 11 Oct. 2018, nyti.ms/2N3faRP.
Zielinski, Ruth, et al. “Planned Home Birth: Benefits, Risks, and Opportunities.” International Journal of Women's Health, Dove Medical Press, 8 Apr. 2015,