The Dire State of Maternal Health in the United States on International Day of the Midwife
The word is finally out — the US is facing a maternal health crisis. The statistics are horrifying — the number of women who have lost their lives giving birth in the United States each year has doubled in the last 25 years.
The United States is the only industrialized country with a rising maternal mortality rate. And the picture is even more grim for women of color and women in low-income communities who face disparities in how they are treated, their ability to access care, and their health outcomes. So what can we do to improve this dismal picture?
Today, on the International Day of the Midwife, we say ‘Call the Midwife’. Midwives are the system’s experts in supporting uncomplicated, healthy childbirth. A strong health system ensures access to the right level of care at the right time — neither too little, too late, nor too much, too soon. In maternity care, that means that specialists and surgeons are available when complications arise, but it also means that women with healthy, low-risk pregnancies can find the low-tech, high-touch care that gets the best results for the majority of women and babies.
The World Health Organization suggests midwives as the first-line health care providers for the 87% of women with uneventful, healthy pregnancies. European countries — where maternal deaths are just a fraction of what we see here — offer a dramatic contrast to the United States. In Britain, France, the Netherlands, New Zealand, and many other developed nations, midwives serve as the most common providers of maternity care. Here in the US, midwifery care is the exception rather than the rule, with midwives attending less than 10% of all births. Many women in the United States do not know what a midwife does or how to access their care to support a healthy pregnancy, childbirth, and well-woman care beyond this period.
Maximizing Midwifery in New York, a recent report by Every Mother Counts and Choices in Childbirth, presents evidence that care by midwives can do just that. Midwives are among the most highly valued and undervalued assets in the American health care system. Extensive research shows that midwifery care achieves results as good as or better than physician care on a number of important quality measures, including low cesarean rates, high rates of breastfeeding, and strong newborn outcomes. In fact, there were no areas where midwifery care showed worse results.
Improving women’s and babies’ health and their experience of care means we need to start integrating more midwifery care into our system. But if you’re not persuaded yet, examine the financial implications. The cost of childbirth care has tripled between 1996 and 2013, in large part due to rapidly rising rates of cesareans. The American College of Obstetricians and Gynecologists and other leading quality improvement organizations all agree that cesarean rates are too high — today, 1 in 3 births is by cesarean.
What’s the link between skyrocketing costs and surgical births? Cesareans cost 50 percent more on average than a vaginal birth, the same ratio whether private insurance or Medicaid is paying the bills. In New York City alone, where 61 percent of births are covered by Medicaid, reducing cesareans by 13,300 would be expected to save $36 millions of Medicaid spending and $47 million in private insurance annually. Midwives can align spending and outcomes, because they are trained to approach pregnancy and birth as a healthy, normal life event, reserving medical procedures for times when they show a demonstrated benefit.
The Midwifery Model is a “relationship-based” model of care. Midwives are trained to build and maintain trust to provide quality and respectful care, as well as emotional support for their patients. Every Mother Counts invests in grantee partners, such as Commonsense Childbirth in Florida, where Jennie Joseph’s Easy Access Clinics demonstrate the impact of midwifery in action. Jennie provides every woman, regardless of insurance, race, or immigration status, the opportunity to have the healthiest possible pregnancy, birth and postpartum. Women, families, babies, and communities thrive because of her four cornerstones of care — access, connection, knowledge and empowerment. It is especially important in marginalized communities where women are more likely to be treated poorly, with their concerns and voices going unheard by medical providers and staff.
Over the last two and a half years, we conducted in-depth interviews and surveys with hundreds of women across New York State and analyzed their feedback. People were dissatisfied and described a system that had become depersonalized. One woman summed up her experience this way: “I felt like a number. During the most joyful, beautiful time in your life, you’re just another patient on a checklist to get through today.” Others described their experiences in more troubling terms as being rushed, harassed, ridiculed, humiliated, neglected, coerced or even forced into procedures without consent.
We need to bring respectful and compassionate “care” back into “health care.” The results are clear — midwifery care can help to ensure more safe and healthy births and more respectful, empowering care. It can also shift spending from a costly, low-value, procedure-intensive approach to a model that is high-value. To accomplish this, we need more midwives and education programs that bring midwives and physicians together in a collaborative model. We need our government to support policies that facilitate midwives’ seamless integration into our health care systems such as equitable reimbursement and lifting restrictive regulations. And we need to do this now. Our mothers’ lives depend on it.
Christy Turlington Burns, Founder & CEO, Every Mother Counts
Jennie Joseph, Founder & Executive Director, Commonsense Childbirth
