Trying to decide between care providers to help you give birth? See why a growing number of moms are choosing midwives.
Most women in the United States who are planning their baby's arrival rely on an obstetrician for delivery. But outside of our borders, midwives have long been the go-to care providers during childbirth. The American Public Health Association and WHO recommend midwives as the primary maternity care providers for the majority of women and in recent years, we're seeing a shift in the number of women in the U.S. choosing this model of care. In 2014, midwives attended 8% of all hospital births, an 11.1% increase since just 2005. Midwives also attend most out of hospital births (home birth and birth center births), too.
One reason behind the trend? The fact that some common hospital practices (like laboring in bed and the routine use of pitocin) can lead to riskier and more emergent birth. Statistically, the midwifery model of care has much lower rates of unnecessary intervention, says Dr. Emiliano Chavira, a maternal fetal-medicine specialist who also practices obstetrics at California Hospital Medical Center. "In low risk women, midwives have been shown in multiple studies to generate fewer complications, better outcomes, and at a lower cost, compared to OB-led care," Dr. Chavira says.
OB/GYN Dr. Jennifer Lang, author of The Whole Nine Months, agrees that midwives offer some things that most OBs can't. "Many women are seeking a birth experience where they feel closer to their healthcare provider which results from longer prenatal visits, and more personalized, hands-on involvement in the labor process. This closer relationship translates into less intrapartum medical intervention. Most obstetricians would love to be able to provide more personalized, hands-on care of their patients, but the economics of the current healthcare climate are not supportive of this."
Here are a few reasons why some American mothers say they decided to have midwives support their births:
1. More choices during childbirth
Susan DiNatale, a certified professional midwife at Kindred Hearts Community Midwifery in Dover, DE, says she believes more women are choosing midwives because they "want to feel their choices are respected and supported" during delivery. Mother of two Carmen Guido Calvo chose midwives for both her births for that very reason. Calvo had desired a home birth, but due to preeclampsia, needed to give birth in the hospital, with her midwife stuck by her side. "She tried to keep me low risk for as long as possible—I love that the midwifery model focuses on prevention, rather than just putting the fire out once it ignites."
For her second baby, Calvo wanted to try home birth with midwives again, and this time she was successful. She calls that birth "a really healing experience" and one where she felt in control and respected. "My midwife and birth team let me lead the way. They were hands-off and allowed me to labor uninhibited," she says.
2. Supportive care for a VBAC
Some mothers who've had a previous cesarean birth turn to midwives because they want to be given the option to have a trial of labor, rather than a planned cesarean. While it is well-documented that VBAC (vaginal birth after cesarean) is a safe option for most women, it can sometimes be challenging to find an obstetric practice that even attends VBAC. Some hospitals across the US have banned it or have rules and regulations in place that do not support it, like forcing mothers to labor on their backs or the use of constant fetal monitoring—both which lead to high rates of cesarean.
Mother of two Meghan Seipp says that's why she sought out midwives. "I knew I wanted a VBAC and wouldn't be able to accomplish that with the OB practice I had with my first," she says. "I got the vibe that when push came to shove, my choices wouldn't have been their first priority." Seipp was able to have a successful VBAC delivery under supportive midwifery care.
3. Better chance at an uncomplicated birth
For some mothers who use midwives, the choice is purely statistical. In a recent systematic review of studies that compared midwifery care to physician care, researchers found midwives had "lower rates of cesarean birth, lower rates of labor induction and augmentation, significant reduction of third and fourth degree perineal tears, lower use of regional anesthesia and higher rates of breastfeeding."
For Lindsay Jones, the choice was as simple as that. "I wanted my best chance at having a normal, unmedicated, vaginal birth," she says. She says her midwife supported her through 30-plus hours of labor during her first birth, something she wasn't sure would've been made possible had she chosen a different model of care.
4. Having less interference postpartum
For many women, what happens right after they give birth is an important part of their overall birthing experience. But hospital policies can dictate a mother's first moments with her baby. Trish Law used midwives with all three of her babies because she wanted to be able to hold her babies skin-to-skin right after the birth. Her obstetrician was up front in letting her know that having immediate "kangaroo care" wasn't an option. "My OB said I couldn't wear my own clothes in case of emergency and that kangaroo care wouldn't work. Baby would have to go to the warmer right away, even if healthy." Law wasn't willing to compromise on those first moments with her children. "It was important to me because it is evidence-based and intuitively made sense that whisking baby from its only constant would be stressful." Midwives allowed her to have immediate skin-to-skin contact at all three of her births.
5. The desire for a more personal experience
"Midwives, as a general rule, pay more attention to the emotional aspects of pregnancy and childbirth, which makes sense because it is an explicit part of their training," says Dr. Chavira. So it's understandable that women who are looking for a more personal experience may opt for midwifery care.
Heather Brown, a mother of three, tried an obstetrician at first, but says it didn't feel it was a good fit. "I found their practice over-scheduled and understaffed," she says. "No one made eye contact. The doctors didn't even ask my name." So Brown turned to a midwifery practice and found them more willing to take their time with her and answer her questions. Brown was so moved by each of her children's births that she became a certified childbirth doula and now helps other moms with their births.