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Friday, January 18, 2019

America needs more midwives, especially in rural areas, say the editors of Scientific American magazine

America needs more midwives, especially in rural areas where it's hard for pregnant women to access hospital care, write the editors of Scientific American magazine.

American maternity care is in bad shape: "Despite the astronomical sums that the U.S. spends on maternity care, mortality rates for women and infants are significantly higher in America than in other wealthy countries," they write. "Moreover, the rate of cesarean sections is exceedingly high at 32 percent — the World Health Organization considers the ideal rate to be around 10 percent — and 13 percent of women report feeling pressured by their providers to have the procedure."

Midwife care is at least as common as obstetrician care in many other developed countries, but in the U.S. only 8 percent of births are attended by midwives. That makes little sense, the editors argue, since certified American midwives must have an accredited graduate degree and at least two years of training, making them plenty qualified to care for low-risk births.

So why aren't midwives more popular in the U.S.? "The roots of America's aversion to midwifery go back to the late 1800s, when the advent of germ theory and anesthesia reduced much of the danger and discomfort associated with childbirth," the editors write. "The benefits of these technologies brought doctors to the forefront of maternity care and pushed midwives aside. Obstetricians helped to bar midwives from practicing in hospitals, which were now considered the safest birth settings. By the early 1960s midwifery was virtually obsolete."

Midwifery has gained a little ground since then, but some states still don't recognize them as qualified practitioners or limit what they're allowed to do. Midwives must be fully embraced by state governments, insurance companies and the medical community to ensure pregnant women can routinely and affordably access such care, the editors write.

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