Letter: Midwives provide the best care to expectant mothers

In a yaledailynews.com comment posted Oct. 21 to the article titled “Midwives speak on birthing” (10/21) an anonymous author implied that “if something goes wrong” with a midwifery-managed birth, death may ensue. The comment ended with, “Thanks, but I’ll stick with hospitals and modern medicine.” I’d like to address two issues raised by this comment: the issue of the safety of midwifery-led care and the issue of choice.

The Cochrane Collaboration, an organization that conducts systematic reviews of health care interventions, published a review titled “Midwife-led versus other models of care for childbearing women,” on Oct. 8, 2008, which looked at 11 randomized trials that included 12,276 women. The main discovered benefit of midwifery care was that there was a statistically significant reduced risk of losing a baby before 24 weeks. Other benefits included less episiotomies and instrumental births, increased chance of a vaginal birth and successful breast-feeding, and more women feeling like they were in control during labor, with no adverse outcomes found. There was no statistically significant difference of overall fetal loss/neonatal death after 24 weeks gestation in midwifery-led care versus other models of care. The authors concluded that all women should be offered midwife-led models of care, and women should be encouraged to ask for this option.

Midwifery care is a safe and evidence-based option for the expectant family. Midwives are experts on normal birth and treat it as such. We are also trained to recognize the pathologies that sometimes develop during a pregnancy or labor and to know when to collaborate, consult or transfer care to an obstetrician, the expert in the pathologies of pregnancy. As a midwife, I support the choice of the anonymous commenter to choose pregnancy management with modern medicine, as I support all women having a choice about their health care. But I believe that for women to make informed choices regarding their health care, we need transparency in maternity care policy and a way to disseminate researched based evidence to the consumer.

Penni West

The writer is a certified nurse-midwife candidate at the School of Nursing.

Comments

  • Melissa

    If something goes wrong with a medically managed birth, death may also ensue.

  • heartsurgeon

    "Midwives are experts on normal birth "

    well, that's the rub isn't it?
    when the delivery becomes problematic, and you don't know until it happens…then you need a gynecologist, a hospital, and a NICU….

    i don't know any physician's who would chose to use a midwife over a hospital based obstetrician, but gee..what do i know….

  • fabian

    Dear heartsurgeon,

    When I need a valve replacement I will come see you. That doesn't mean I need you around all the time just in case.

    I'm sure youur opinion is totally unbiased but I think I will stick with Penni's well-reasoned, evidence-based arguments.

  • Kathryn

    Why not have the best of both worlds and have a midwife assisted childbirth in a birthing center of a hospital. I did that with my son, close to 30 years ago, and didn't need a doctor and therefore didn't see a doctor, but was glad that one was close by in case something went wrong.

  • Homebirther

    Doctors see only sick people, and eventually see sickness *everywhere.*

    As the article writer noted: statistics are in favor of midwifery They tend to screen their clients, and accept only healthy, normal pregnancies--they understand that, yes, SOME pregnancies may require intervention, but the VAST MAJORITY do not. Indeed, heartsurgeon, midwives DO "see it coming."

    My first doctor convinced me to do an amnio--leading me to no end of worry. After that, I never agreed again (even though EACH time I was flagged as "elevated risk" for birth defects).

    During my third pregnancy, I indeed developed a situation that required medical attention--and I sought and received great care; it did not affect the baby. Then, against advice similar to that of heartsurgeon above, I delivered at home. My doctor, although she could not articulate the risks, just thought it "safer" if I had the birth in a hospital. She was very upset when I declined.

    Doctors, like police, eventually see more of the bad than the good. I don't blame them for it, but I am not going to let it run my life.

  • Goldie '08

    "Midwives provide the best care to expectant mothers."

    Yes, and medieval barbers provide the best care to the sick and injured.

    "You have a stomachache? Bloodletting should take care of that in a jiffy!"

  • Amy Tuteur, MD

    Ms. West,

    You've misrepresented the results of the Cochrane review. The review tells us nothing about the comparison between midwifery care and physician care, because that is not what it looked at. The study compared two different models of team care. Virtually every woman in both arms of the study was cared for by midwives AND doctors. The study only looked at the role of the midwife within the team (leader vs. participant).

    "Midwifery care is a safe and evidence-based option for the expectant family. Midwives are experts on normal birth and treat it as such."

    CNM care is a safe and evidence-based option. However, midwives are not experts on normal birth. Claiming to be an expert in normal birth is like a meteorologist claiming to be an expert in good weather: useless. Every woman deserves to be attended by a practitioner who is an expert in managing complications, since that is when expertise really counts. An uncomplicated labor can become a life threatening emergency at a moment's notice.

    The fact is that childbirth is, and has always been, in every time, place and culture, a leading cause of death of young women. In addition, the most dangerous day of the 18 years of childhood is the day of birth. It may not seem that way here in the US, but that's because modern obstetrics has been spectacularly successful at lowering both maternal and neonatal mortality rates. Nonetheless, we should never forget that childbirth is inherently dangerous and that life threatening complications can occur in any woman at any time.

  • Hieronymus

    "The fact is that childbirth is, and has always been, in every time, place and culture, a leading cause of death of young women."

    Puh-leaze!

    National Adolescent Health Information Center ranks the following causes of death for young women:
    1.Accidents (often involving alcohol and cars)
    2.Homicide
    3.Suicide

    And the leading causes of death overall?
    1.Heart disease
    2.Cancer
    3.Iatrogenic disease (i.e., doctor-induced)

    In a mind boggling article published by The Journal of the American Medical Association (Vol. 284. No. 4 - July 28, 2000) the research finally admits to mainstream that they are killing 250,000 Americans per year. They estimate the figure to be low and thatr these are only the death figures, not the adverse side effects associated with disability or discomfort.

    12,000 - unnecessary surgery
    7,000 - medication errors in hospital
    20,000 - other errors in hospitals
    80,000 - nosocomial infections in hospitals
    106,000 - adverse effects of medications

    "Nonetheless, we should never forget that childbirth is inherently dangerous and that life threatening complications can occur in any woman at any time."

    That's right: SCARE us into conformance… SCARE us into supporting outrageous practices and unnecessary costs… SCARE us into rationalizing "the machine that goes 'bing'" (not to mention your salary).

    And as for "Goldie '08": great use of those research and rhetorical skills honed at Yale. Sheesh.

    You will note that those in favor of midwife assist ALWAYS allow that it is not for everyone. I hope folks ALSO note the scare tactics and outright brainwashed response of those who oppose it.

    Where do ppl get sick? Where do killer bacteria fester? Where do the old go for help but instead receive antibiotic resistant illness?

    Hint: It ain't the Birthing Center…

  • Amy Tuteur, MD

    According to the CDC:

    In 2004, in rank order, the 15 leading causes in 2004 were: 1) Heart disease, 2) Cancer, 3) Stroke), 4) Chronic lower
    respiratory diseases, 5) Accidents, 6) Diabetes mellitus, 7) Alzheimer’s disease, 8) Influenza and pneumonia,
    9) Kidney disease, 10) Septicemia, 11) Suicide), 12) Chronic liver disease and cirrhosis, 13) Essential hypertension, 14) Parkinson’s disease, and 15) Homicide.

    The causes of death differ by age. Among women age 15-34 the leading causes of death are accidents, homicide, suicide, cancer, heart disease, HIV and pregnancy complications. As I said above, childbirth is, and always has been, a leading killer of young women. Even today, in industrialized countries where the maternal mortality rate has decreased 99% from 100 years ago, childbirth is the #7 killer of young women.

  • Penni West

    Amy T.,
    You stated, "You've misrepresented the results of the Cochrane review. The review tells us nothing about the comparison between midwifery care and physician care, because that is not what it looked at."

    You've misread the review I wrote of the Cochrane Review. I noted the differences between midwifery led care and other models of care. Please be careful not to infer meanings into what has not been stated. It causes confusion and is misleading. See the Letter to the Editor if you need to re-read the exact wording.

    Penni