Research out of New Zealand shows that midwife-led births aren't as safe as doctor-led, but should you worry about using a midwife here in the U.S.?
A study of New Zealand's maternity healthcare created a shockwave of controversy around the globe, as it found worse birth outcomes among births led by midwives rather than doctors. Women in New Zealand, a country in which four out of five women use a midwife as their lead practitioner, were understandably concerned. The Ministry of Health is even asking for an investigation into their healthcare system. But what do the study's results mean for women elsewhere interested in a midwife birth?
Inside the study
Researchers at the University of Otago in Wellington, New Zealand, published the first study of the country's midwife-based maternity system in the journal PLOS Medicine. They found that of the over 244,000 women in the study, those who had doctor-led care had 55 percent lower odds of oxygen deprivation during delivery (birth-related asphyxia), a 39 percent reduced risk of neonatal encephalopathy (a condition that can lead to brain injury), and 48 percent lower odds of a low Apgar score (a measure of how good a baby is doing right after delivery).
This study focused on New Zealand's maternal care options, which differ from other countries. In New Zealand, midwife care is free, as is care from an OB for high-risk pregnancies. Low-risk women can choose to pay for OB care if they want. Karen Guilliland, chief executive of the New Zealand College of Midwives, argues that the government hasn't adequately funded maternal care, causing a gap in care received by the rich and the poor. So, disadvantaged women with more health issues may end up seeing midwives, potentially skewing the study's results.
Critics of the study within New Zealand itself stress there are other factors at play besides the quality of care from midwives. "The researchers couldn't measure all the contexts [and] circumstances that women and babies are in," Guilliland said, highlighting the additional challenges midwives there face, such as having patients who live remotely or who may have other existing medical conditions. The study's authors, though, say that the point of the study wasn't to address the question of midwife versus doctor, but to specifically examine New Zealand's maternity system. Ellie Wernham, lead author and a former midwife herself, admits that although they tried to account for differences among the patients, there still could be outside influences. "Contributing factors could include high-risk mothers receiving midwife care inappropriately, staffing issues, collaboration issues, the level of training midwives receive, and delays in mothers being referred to a medical professional," she said.
Even with these concerning results, New Zealand's maternity system had similar overall birth outcomes to countries like England and Australia. And other studies have shown that midwife-led births have greater patient satisfaction and fewer medical interventions than doctor-led births. "As a practicing midwife I saw firsthand the many benefits of our midwife-led model," Wernham said in a statement. "However our study has identified that there may be aspects of our maternity system where improvements can be made."
Should you call the midwife?
Experts say not to get too hung up on these results. "Generally speaking, American women should not worry about seeking care from a certified nurse midwife," says Nanci F Levine, M.D., OB/GYN, Department of Obstetrics & Gynecology and Women's Health, Montefiore Health System in Scarsdale, N.Y. "That said, only low-risk, healthy women—women not taking medications or seeking care for an ongoing medical issue, such as diabetes, obesity, or chronic hypertension—who maintain a healthy weight should seek prenatal care from a certified nurse midwife. Patients should ask their doctors if a certified nurse midwife is a good option for them."
In the U.S., insurance will cover at least a portion of care from either an OB or a midwife. Only about 8 percent of American mothers have babies delivered by midwives, and they are usually very low-risk—midwives refer high-risk patients to OBs. Although midwives are not totally integrated with doctors in our healthcare system, that is changing. A joint statement in 2014 from the American College of Obstetricians and Gynecologists and the American College of Nurse-Midwives said they are working toward better communication, to ensure better healthcare for all moms.
The bottom line? Take this study with a grain of salt. The issue of midwife versus doctor is complex, and results from one healthcare system can't be applied to another. Talk to your providers (midwives and/or OBs) to see which type of care is best for you and your baby.