Maternal & Infant Health

How midwives help outcomes for women and babies

Natasha Takyi-Micah
Treuhaft Fellow for Health Planning
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May 10, 2021
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The United States experiences unprecedentedly high rates of maternal deaths. In a study that compares the United States to 10 other developed countries, women in the United States had the highest ratio of maternal deaths. For example, there were 17.7 maternal deaths per 100,000 live births in the United States compared to 1.7 maternal deaths per 100,000 live births in New Zealand and 3.0 maternal deaths per 100,000 live births in the Netherlands.[1] Further, there are racial disparities in maternal deaths in both the United States and Ohio as Black women are more likely to die from maternal or pregnancy-related deaths compared to white women. Midwives can help reduce the chances of maternal and infant deaths, but unfortunately, compared to the other developed nations in the study, the United States and Canada use the fewest midwives, with four midwives for every 1,000 live births. [2] Moreover, midwives can prevent the use of hospital interventions during labor and produce positive health results. Thus, an analysis on the positive outcomes of using midwives is worthwhile to explore.

 In a study that compares the United States to 10 other developed countries, women in the United States had the highest ratio of maternal deaths.

One of the advantages of using midwives is the reduced chance of performing birthing interventions/procedures. One study shows that women who received midwifery services experienced a lower chance of epidural usage, episiotomy and the use of forceps/vacuum - also known as “instrumental vaginal birth.” [3] In another study, researchers examined the different birthing interventions when women received care from either midwives or obstetricians. After examining the responses from 2,539 women in a California survey, those who obtained help from midwives compared to obstetricians were less likely to receive any pain relief medication (71.6 percent with midwife assistance and 81.7 percent with obstetrician assistance ) and synthetic oxytocin (37.5 percent with midwife assistance and 42.3 percent with obstetrician assistance).[4] Also, women who received assistance from midwives were more likely to use nonpharmacologic comfort interventions during labor such as walking, hot/cold compresses and a shower or tub.[5] Based on the results of these studies, midwives seem to assist low-risk women go through natural births with minor use of medical procedures.  

Midwives also produce positive health outcomes for mothers and babies. Some of the positive health results include a reduced chance of losing babies under 24 weeks of gestation [3] and higher breastfeeding rates. [6] Locally, researchers examined neonatal outcomes and birth interventions among low-risk pregnant women who received prenatal care from either midwives or physicians at The Ohio State University Wexner Medical Center. [7] After completing this study, women who obtained prenatal care from midwives had a 42 percent lower risk of experiencing preterm births.

 Overall, midwives can create encouraging outcomes for both women and children.

Another study observed whether there would be a possible reduction of fetal, neonatal and maternal deaths if there was an increase in midwifery coverage in 78 low to middle-income nations. [8] The nations were classified into three categories based on the Human Development Index (HDI) - a statistic comprised of education, life expectancy and income indexes - and the estimated number of prevented deaths. Group A consisted of the lowest HDI countries, group B included low-to-moderate HDI countries and group C involved moderate-to-high HDI countries. After grouping the countries into three categories and making projections, if there was a modest increase, 10 percent for every five years, in midwifery coverage, then maternal deaths could be reduced by:

  • 4 percent for group A
  • 9 percent for group B
  • 7 percent for group CMoreover, if there was universal midwife coverage for maternal and newborn health interventions for countries only listed in group A, then "60.9 percent of all maternal, fetal, and neonatal deaths could be prevented."[9] Although the United States was not a part of this study, similar results could happen here if there was more midwifery coverage.  

Overall, midwives can create encouraging outcomes for both women and children. Pregnant women could have more freedom to choose whether or not they want hospital interventions during labor. In addition, women and babies could yield positive health benefits, including a decreased chance of death. Due to this research supporting the benefit of expanded midwifery on maternal and infant outcomes, legislators in Ohio should consider policies that will allow more midwives to become certified and practice. Furthermore, there should be more awareness about midwives in the public so women can decide whether or not they want to receive such services during pregnancy and birth. Midwives can help save the lives of mothers and babies in Ohio which could help resolve this public health issue.  

  1. Tikkanen, R., Gunja, M. Z., FitzGerald, M., & Zephyrin, L. (2020, November 18). Maternal mortality and maternity care in the United States compared to 10 other developed countries. The Commonwealth Fund. ibid.  

3. Sandall, J., Soltani, H., Gates, S., Shennan, A., & Devane, D. (2013, August 21). Midwife-led continuity models versus other models of care for childbearing women. Cochrane Library.  

4. Declercq, E. R., Belanoff, C., & Sakala, C. (2019, August). Intrapartum care and experiences of women with midwives versus obstetrician in the Listening to Mothers in California survey. Journal of midwifery & women’s health, 61(1), 45-55.  

5. ibid  

6. Vedam, S., Stoll, K., MacDorman, M., Declercq, E., Cramer, R., Cheyney, M., Fisher, T., Butt., E., Yang, T., & Kennedy, H. P. (2018, February 21). Mapping integration of midwives across the United States: Impact on access, equity, and outcomes. PLOS One, 1-20.  

7. Weisband, Y. L., Klebanoff, M., Gallo, M. F., Shoben, A., & Norris, A. H. (2018, June, 26). Birth outcomes of women using a midwife versus women using a physician for prenatal care. Journal of Midwifery & Women’s Health, 63(4), 399-409.  

8. Homer, C. S. E., Friberg, I. K., Dias, M. A. B., Hoope-Bender, P. T., Sandall, J., Speciale, A. M., & Bartlett, L. A. (2014, June 22). The projected effect of scaling up midwifery. The Lancet, 384(9948), 1146-1157.  

9. ibid  

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