Access to Midwifery Care Improves Maternity Outcomes

by Tina Johnson, CNM, MS, ACNM Director of Professional Practice & Health Policy

The Patient Protection and Affordable Care Act will bring millions of newly insured citizens into the health care system. In order to meet the country’s needs, leaders are calling for high value, evidence-based solutions. Let’s start with the health condition that affects 100% of all Americans...childbirth! How can we provide high quality, high value maternity care for all women and families? The answers are in the evidence: midwifery care improves maternal and newborn outcomes and patient satisfaction, reduces health disparities, and saves money and resources.

The U.S. grossly outspends every other nation per capita on health care, yet our maternal and newborn outcomes lag far behind those of other developed nations. Childbirth is the number one reason for hospitalization, and its related hospital charges surpass those of any other health condition. Resource-intensive interventions like labor induction, epidural analgesia and cesarean section are overused, often without indication or consideration of alternatives, resulting in increased risk of maternal and newborn harm.

Cesarean section is the single most common operating room procedure in the U.S., and the rate is steadily climbing. Incredibly, in 2007, nearly one-third of American women delivered their babies by cesarean section. Maternal mortality has risen dramatically, and glaring racial disparities in maternal and neonatal outcomes persist.

How can we reverse these disturbing trends? Ensure that all women have access to maternity care providers and practices that support the normal processes of birth. Labor support, freedom of movement, intermittent monitoring, alternative birth settings, vaginal birth after cesarean...all have been identified as evidence-based practices that are underused.

Midwives truly are the experts in supporting healthy vaginal birth in all settings. Midwives caring for low-risk women improve infant mortality rates in both hospitals and birth centers when compared with physicians caring for equally low-risk women. Midwife-led models of group prenatal care reduce preterm and low birthweight rates and improve patient satisfaction. Birth centers provide improved outcomes for even the most at-risk women, reducing preterm birth, low birthweight and cesarean section rates, and reducing costs to our health care system. Skilled midwifery care is the gold standard among nations with the best maternal and neonatal outcomes, and has been identified as essential to reducing maternal mortality worldwide.

It’s time to bring that message back home. The time is now to promote and support midwifery in America—and to follow the evidence.

This post was originally published on the the Center to Champion Nursing in America (CCNA) blog. Visit CCNA to join more conversation about this post.

Nurses Stand with Obama; Are Midwives Next?

by Dawn Durain, CNM, ACNM Vice President

I was trying to find some news coverage on the Sonia Sotomayor hearings on Wednesday afternoon, when suddenly there was President Obama on the White House steps surrounded by women! This being an atypical sight, I quickly unmuted. As it turned out, the people accompanying the president were mostly nurses and members of the Congressional Nursing Caucus—nurses in the Rose Garden! Nurses were being praised by the president for their dedication, ability to convey complex information to patients, and skills in caring for women in labor and their nervous husbands—all of this from the personal experiences of President Obama no less.

The occasion of the speech was, of course, to mark a significant step by Congress toward health care reform. I encourage you to read the Senate and House legislation and the president’s speech for yourself. I find the recognition of the work of nurses refreshing—more refreshing than the recent spate of TV shows featuring nurses for sure! I found myself hoping for the impossible though. Would the president mention nurse-midwives when he spoke of his experiences when his daughters were born? He didn’t. Would he mention the importance of nurse practitioners, certified nurse-midwives (CNMs), and certified midwives (CMs) as primary care providers when he spoke of the need for coordinated health care? He didn’t do that either. But, the legislation he referenced does, thanks to the hard work of our ACNM staff and midwives around the country who are talking and talking and talking to their representatives in Congress. Wednesday felt like a giant step forward. And maybe next time the White House will invite a midwife to the Rose Garden!

On a personal note, I’d like to give a shout-out to Keisha Walker, one of the nurses President Obama introduced who was there with him. She is a graduate of the University of Pennsylvania Graduate School of Nursing and worked on two projects in my Public Policy class at UPenn. She was passionate about nurses being involved in the political process and about the ability of nurses to have an impact on reproductive health care policy. She is currently at Johns Hopkins as a nurse researcher in their MPH program and clearly still involved in health care policy. Way to go, Keisha! Who is next in line to talk to the president about midwifery?