The King’s Fund– a UK health care think tank– recently looked at studies from the UK and other countries to determine how to best increase safety in maternity care without increasing spending. Based on all the research they complied, the organization is recommending an increase in midwife-led care for low-risk births. One of the UK studies concluded that £2.5 million could be saved just by getting midwives, rather than doctors, to examine healthy newborn babies.
The Fund noted that last year only 10% of hospital births in England were in “midwife-led wards.” In America, I’m guessing that number is even lower. Our model of care if very much obstetrician-led. Now, let me be clear: midwife-led does not mean doctors have no role. Quite the opposite. It simply means that everyone does what they do best. Midwives handle the care of women throughout pregnancy and birth, and doctors handle medical problems that come up.
Just for fun, let’s see what midwife-led care would look like if we had it here:
You get pregnant, you go to a midwife. She does the initial consultation and orders any tests that might be necessary–routine blood work, etc. Most women, whose pregnancies fall within the wide range of “normal,” would continue with the midwife. If necessary the midwife will set you up with sonograms, prenatal screening or testing for chromosomal abnormalities, gestational diabetes screening, blood pressure monitoring, nutrition counseling, etc, etc. Basically everything an ob/gyn does. (This can be surprising to people in the US, as midwives are often associated with a strong opposition to technology or “medical” procedures; they are, in fact, trained medical professionals who can write prescriptions, etc. etc.) Those women for whom a particular health condition requires more specialized, “high risk” monitoring or treatment would either consult with doctors who specialize in such things or be transferred to them for full prenatal care.
When birth comes around, midwives are the first line of support, tending to most mothers throughout their entire labor and delivery and newborn assessment. In the case that a c-section is required the midwife will arrange for a doctor to perform the surgery– whether this is ahead of time due to a medical condition such as placenta previa or in mid-labor due to fetal distress.
Birth, while extraordinary, is actually just a bodily function. Sometimes it goes from being a normal bodily function to a medical situation, then you get your specialist to step in. Think about it, you only call a doctor when you’re sick, right? Well, pregnant women aren’t inherently sick. They are pregnant. If they become sick, call the doctor! But if they don’t, as is the case with the majority of pregnancies, we have an entire midwifery profession to provide incredibly smart, noninvasive, low-risk support. The midwifery model of care is pretty hard to come down on– it’s very respectful of each woman’s individual circumstances both in terms of her health and her frame of mind.
Midwife-led care is the norm in most of Western Europe where statistics for maternal and fetal health are excellent. Unfortunately, the numbers of midwife-led births are starting to decrease in Australia and England. The King’s Fund reports that last year only 10% of hospital births in England were in midwife-led ward, and warns that, due to financial pressures, it’s unrealistic to expect that this will improve. You can read more about the situation in England here.
As for America, I think that the Obama Administration should be looking closely at how midwife-led care as a way to save us untold billions in health care costs. (According to a recent study, we could save 3.5 billion dollars in those health care costs just by cutting the national c-section rate by 11 percent! Based, on examples from around the world, it’s clear that midwifery care reduces the overall number of medical and surgical interventions.)
But we wouldn’t just save money, we’d be providing women with the best of both worlds: quality midwifery care and outstanding obstetric back-up. We have both of those things to offer in this country! We’ve got to stop fighting about which kind of care is *better* and instead fight for what we need: Midwives and doctors working together, serving women.
“Like” The Big Push For Midwives on facebook to help join the fight to bring midwives into the mainstream.
This is post #4 in a week-long series on themes in “natural” childbirth.
photo: vox photo/flckr