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Do Midwives Have Something to Teach Doctors?

In the U.S., we tend to think of midwifery care as a leap of faith and births overseen by a medical doctor as the safest and most certain. We uphold the belief that doctors are superior through anecdotes from friends' experiences, stories our moms told, harrowing news stories, assumptions about medical school and distorted histories about how things used to be. We sigh and make allowances for midwives so that women can indulge their more primal impulses, but deep down we hold our collective breath until home birth mom and baby post a cute picture on Facebook.

Of course, not everyone thinks like this. I'm just describing the general attitude that colors the approach to care for—and the kinds of care available to—pregnant women in the U.S. Lots of health insurance plans won't cover midwifery care. Or ones that do frequently mandate that, during the actual birth, a doctor take the place of the midwife who cared for you throughout pregnancy. Many hospitals won't let midwives attend births. Many midwives can't afford to attend births in hospitals, because medical malpractice insurance is unaffordable, since they earn quite a bit less than OB/Gyns.

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All this despite a growing body of evidence that concludes midwifery care—and midwife attended births—have outcomes that are just as good, if not better, than those of doctors.

A new study found a lower rate of pre-term birth among women cared for by midwives during their pregnancies. The U.K. study also found fewer complications during midwife-attended births and fewer medical intervention like episiotomies, vacuum extractions and forceps deliveries.

Researchers haven't yet found a smoking gun that linked midwives to these better outcomes, though opponents of midwifery care often say the numbers are all skewed because doctors have to take high-risk pregnancies which water down their rates of success (and it's a fair argument but this study and others correct for that).

We need to approach the discussion not from the frame of mind that midwifery care is all about the mom while a doctor's care keeps in mind the baby. Both want a healthy mother and a healthy baby.

So this is where we get into a fight about which is better—midwifery care or a doctor's—when it comes to pregnancy and birth. But I think that's an unproductive fight and one that doesn't go anywhere. What these studies tell us is that trained midwives are a safe option for low-risk pregnancies for women who want them, and this includes home births. Is it a risk-free choice? No. But birth, while relatively safe in these modern times, isn't risk-free. That includes birth in a hospital.

When a mother or baby dies during or shortly after a midwife attended birth, all hell breaks lose in the media and criminal courts. When it happens at a hospital, it's equally as tragic—and doctors sometimes get blamed—but the general public doesn't hear much about it. The result is we're suspicious that the care of midwives is inferior to that of a doctor. Stories such as this one, despite reporting good news about the care of midwives, continues to feed that suspicion by interviewing only a doctor about the results. The doctor, predictably, warns that a team of caregivers should monitor a pregnancy and a doctor should be on that team. The reporter lets that stand, even though the study concludes no such thing.

Last spring, the American Academy of Pediatrics, a professional and advocacy group for children's doctors, issued guidelines for home birth, which amounted mostly to a big list of "no duh" for birth attendants everywhere but delivered in a tone that is best described as "if you're really gonna do this, he's how to get out alive." Again, from the assumption that midwifery care is inferior, despite evidence.

I've given birth three times, once in a hospital attended by a Certified Professional Midwife (an RN with a master's in midwifery) and twice at home—the first with a lay midwife (who had been a licensed RN but let it lapse for legal reasons and who would have been a licensed midwife had home births and midwifery care not been a felony in that state at that time. The second was with a licensed midwife who had been a nurse and worked at hospitals earlier in her career.) All outcomes for me and my babies were excellent—and I was even something of an old-lady-therefore-supposedly-higher-risk in that last one. But again, my birth stories are just anecdotes in the bigger picture and are therefore meaningless in terms of scientific inquiry into the safety of midwives and out-of-hospital births.

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It's the science we need to look at—the outcomes statistics and even large-scale studies. Not just one person's fears and beliefs—be it a doctors, a midwife's, a new moms, her family's. And we need to approach the discussion not from the frame of mind that midwifery care is all about the mom while a doctor's care keeps in mind the baby. Both want a healthy mother and a healthy baby. And both have ways of achieving that.

And it's in those ways where there are differences, and what we're now learning is that the midwifery model of care has something important to share with the rest of the class. Will doctors, hospitals and insurance companies listen?

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