Are midwives safer than doctors?
- January 13th, 2015
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In a clinical assessment that could have implications for the United States, Britain’s National Institute for Health and Care Excellence has concluded that it is safer for healthy women with uncomplicated pregnancies to give birth under the supervision of midwives than in a hospital maternity ward run by doctors. The reason: Doctors are much more likely than midwives to use interventions like forceps deliveries, spinal anesthesia and cesarean sections — procedures that carry risks of infection and surgical accidents.
The guidance applies to healthy women who are considered at low risk for complications because they have had no previous complicated birth, they are expected to deliver a single baby at full term and their baby is presenting head first. These mothers and their babies fared better with midwives than with doctors in almost all settings, except for first-time mothers delivering at home.
Last year there were more than 3.9 million births in the United States. Ninety percent of them were attended by physicians and only 9 percent by midwives. Most births with midwives occur in hospitals, with relatively small percentages at free-standing birth centers or at home. Three-quarters of certified nurse midwives, a category that includes the highest number of trained midwives, work in physician practices or in hospitals where they interact with or are supervised by doctors. But they might well acquire more autonomy to handle low-risk, straightforward pregnancies on their own.
Certified nurse midwives are licensed registered nurses. They have typically earned at least a master’s degree from an accredited college, received clinical training, won certification from a national board and passed a state licensing exam. A number of studies have shown that they do as well as or better than obstetricians in low-risk cases.
The professional society for obstetricians, however, cites evidence that planned home birth carries an increased risk of neonatal death, compared with planned hospital birth. It warns that a pregnancy that seems low risk can quickly develop complications that only a hospital can handle.
Some medical centers are trying to have the best of both worlds by allowing midwives greater autonomy within the hospital. The Mayo Clinic, often a pacesetter, lets midwives handle low-risk pregnancies independently and hand off to doctors any cases that become complicated.
In a time of spiraling medical costs and increasing demand for health care, midwives can offer a cost-effective way of providing good maternity care. They could also provide greater geographical reach: Nearly half the counties in the United States have no maternity care professional, either midwife or obstetrician.
Bipartisan legislation pending before Congress would require the federal government to identify areas with significant shortages of such professionals and take steps to plug the gaps. It is backed by the American College of Nurse-Midwives and by the American Congress of Obstetricians and Gynecologists. The bill would help many more women gain easy access to maternity services, and it should be approved.