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