The Latest in Midwifery

This graph illustrates the changes in midwife-attended births over time. Births attended by Certified Nurse Midwives (CNMs) and other vaginal births with midwives are all experiencing upward trends. However, as midwives typically attend low-risk births, one cannot deduce from this graph that the number of low-risk births in the U.S. is also increasing.

The heat map above shows the different percentages of total midwife-attended births in each state in 2018. Percentages of midwife-attended births are lower in the middle and southern U.S., whereas higher percentages can be found in Alaska and the western and northeastern U.S. These data combine births attended by Certified Nurse Midwives (CNMs) and “other midwives” (most of whom are certified professional midwives), therefore a map displaying percentages for one kind of midwife or the other may appear different.

This graph shows where women gave birth depending on their birth attendant. The vast majority of MD and CNM-attended births took place at a hospital, whereas births that intentionally occurred at a freestanding birth center or a home were most frequently attended by other midwives. One caveat of this data is that most births that intentionally take place outside of a hospital are low-risk (MacDorman & Declercq, 2016).

This graph depicts which medical attendants were most common among women of different race/ethnicities. More white women were cared for by other midwives than any other type of medical attendant and MDs delivered more Hispanic or Latino women, Black or African American women, and Asian women. This data is limited by a lack of information about the women’s insurance type, pregnancy risk level, and other factors that can influence choice of medical attendant.

This graph compares a sample of California women’s actual reported use of midwifery care and desire for a midwife at a future birth by race/ethnicity. The difference between actual use and desire for a midwife was greatest for Black, non-Hispanic women (6% vs. 66%)(Listening to Mothers in California, 2018). This data cannot tell us anything about the health or insurance status of the women, both of which could influence the total number of women in each racial group who were for eligible for midwifery care for their recent birth or who would be eligible for a future birth.

This graph illustrates how women pay for their childbirth with various birth attendants. MDs and CNMs had slight majorities of clients using private insurance. In contrast, more women with other midwives paid for their childbirth expenses themselves. Qualitative data from the Listening to Mothers III (2013) and Listening to Mothers in California (2018) surveys indicate that lack of insurance coverage or high cost of midwifery care is a commonly cited reason for not having a midwife among women who initially wanted one for their most recent birth (see some of their quotes in the “Other Cool Stuff” section).

This graph shows what percentages of infants were breastfeeding upon leaving the hospital by medical attendant. Other midwives had the greatest percentage of breastfed babies at discharge while all other attendants were within a few percentage points of each other around 70%. However, these data cannot tell us how many infants were still breastfeeding at various intervals after hospital discharge (e.g. 1 week, 6 months, 1 year, etc.).

This graph shows how often different medical attendants induced labor in their pregnant patients. Overall, a majority of women who gave birth in 2017 did not receive labor induction. Other midwives induced labor in about 20% fewer cases than MDs and CNMs. Both groups of midwives had lower percentages of induced mothers than MDs, which is consistent with research that has shown that midwives employ a less-interventionist model of care that results in lower induction rates than the national average (American College of Nurse-Midwives, 2012). 

Select quotes from Listening to Mothers Surveys:

“During my prenatal care I had the option to use my OB-GYN or a nurse- midwife that I met with on my first visit. I really like both, but chose the midwife because she seem to have more time to spend and was really helpful with resources and wanting to coordinate care with my outside therapist due to ongoing depression issues” (LTM in California, 2018).

“I initially wanted a midwife, a doula and a birth center. Insurance wouldn’t cover this so we went with the traditional OB and hospital route” (LTM in California, 2018).

“Most frustrate[ing] for me is that I always wanted midwifery care for the birth of my child, but my insurance didn’t offer it” (LTM in California, 2018).

“Everyone was telling me to get an OB-GYN, I didn’t know what to do as this was my first one. I wasn’t aware of a midwife” (LTM in California, 2018).

“I would have been at a birth center with a midwife in a heartbeat if this had been an affordable option for us. I wish there had been coverage for these alternatives” (LTM in California, 2018).

“My nurse midwife… protected the process of birth that we both have/had immense respect for. I stand in awe of how beautiful my birth was” (LTM III: Pregnancy and Birth, 2013).

“I appreciate when my midwife and nurses don’t assume the worst because I am overweight. All of my pregnancies have been healthy and natural births. No high blood pressure or gestational diabetes. Don’t judge a book by its cover” (LTM III: Pregnancy and Birth, 2013).

“I felt no pressure to accept any interventions I didn’t want unless my midwife felt it was for the baby’s safety, in which case… the reasons were clearly explained to me and my husband before the intervention was executed. I couldn’t have hoped to be treated with more respect and dignity” (LTM III: Pregnancy and Birth, 2013).

Mothers’ Perceived Barriers to Midwifery Care

  • 56% of mothers believed that their insurance would not cover a midwife.
  • 13% of mothers did not believe midwives could practice in hospitals.
  • 11% of mothers believed that they could not have an epidural with a midwife. 

These figures are from a sub-sample of California women who wanted a midwife but did not end up having one. Misinformation and misunderstanding about midwifery care and a lack of clarity about the availability of midwifery care are common barriers (Listening to Mothers in California, 2018). These numbers cannot tell us how many of these women who wanted a midwife may not have been able to have one due to real concerns about health, safety, or affordability.