Newsflash: Midwives Aren’t Just For Rich New Yorkers

home birthI was pretty excited when I first saw earlier this week that the New York Times had written about the increasing popularity and profile of midwives – until I actually read the article, that is.

It’s not that the article, “The Midwife as Status Symbol,” is wrong exactly. Yes, models like Christy Turlington and Gisele Bundchen used midwives. Yes, they are having something of a moment right now. And yes, the public perception of what midwives do and who they are for is changing. The problem is that the Times only presents a tiny piece of the story.

The article focuses on the popularity of midwives among one specific group of people: well-off, healthy women living in New York City. But aside from acknowledging a desire for a more natural birth and the fact that certain midwives are “status symbols,” the Times doesn’t really get into why someone would want to use a midwife in the first place, which seems like a pretty important thing to discuss.

In European countries like the Netherlands, for example, midwives are common and home births are not unusual. OB/GYNs are available for riskier patients but a normal healthy mother is likely to be cared for by a midwife throughout her pregnancy. C-section rates are lower and birth outcomes better; according to one recent report, European countries like Ireland, Italy, Bosnia and Herzegovina had the lowest maternal mortality rates in the world, while the United States ranked 41st.

Midwives are also licensed in some states – including in New York. The documentary The Business of Being Born looks at midwives operating in New York City in birth centers and in partnership with OB/GYNs. In other states like Kansas and Ohio, midwives are legal but unregulated, and in several states, including Alabama and North Carolina, they are illegal. Medical reimbursement for care by a midwife also varies by state and by insurance provider. If having a midwife is a “status symbol,” it’s at least in part because there are issues of access related to finances, insurance coverage and geography.

In Ontario, where I live, midwives are licensed and their care is covered as part of the provincial health care system for both home and hospital births, just as care by an OB/GYN is. The practitioners are in high demand here too, but not because women are competing for the midwife of the moment; it’s because their care is valued and available to anyone with an Ontario health card.

I personally have an OB/GYN but he was also supportive of my initial interest in using a midwife; having midwives as part of the health-care system here means less burden on OBs, allowing them to better focus on high-risk patients. As part of their embrace of midwives, Ontario’s government recently announced that they’ll build birthing centers in the province, which will hopefully cover some of the demand.

A midwife can be a great choice if you’re hoping for a non-medicated labor – research has shown that giving birth with a midwife results makes the use of interventions like labor induction less likely. But that’s not the only reason to use a midwife; plenty of women who have inductions, epidurals or c-sections have midwives, whether those interventions were planned in advance or came about as labor progressed. A friend of mine had a c-section for medical reasons, and her midwife was with her the entire time – in the OR, and afterward to help her start breastfeeding. It’s not hard to see why that kind of continuous, personalized care is appealing to many women.

Most articles in the NYT Styles section are fluff reporting on rather dubious trends, usually about something kind of silly that people with too much money are doing. That’s not that big of a deal when they’re talking about a hot fashion item, but I would hope that a matter of women’s health and medical care would get a slightly more serious and balanced treatment from the paper.

(Photo: Tatiana Morozova/Shutterstock)

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    • Somnilee

      In the UK every birth has a midwife involved, it’s just part of the obstetric care package. They deliver the baby and do visits to mothers and stuff. It’s such a vital aspect of care that I really don’t understand how it’s an entirely different case in America.

      • Katie

        It’s the same in Australia.

        Midwives are fantastic and are severely under-valued.

      • T.

        Aren’t Australia midwife famous for backing up Lisa Barrett, instead than ditching her as she deserved?

      • Another Steph

        T:

        I’m beginning to think you’re a troll because surely no ordinary person would make such stupid, insulting, and inflamatory comments. Sure, some backed her. Others didn’t. Still others called for legal reform. Reading a few articles about something on the internet doesn’t equate knowledge or understanding.

      • T.

        Well, if making a question is being a troll, I suppose I am one :)

        I don’t know much about midwife in Australia (obviously, since I am Italian, why should I know?). Still, there was a case some time ago that caught the public attention, and of which I remember something. That is why I made the question.

        Believe it or not, it was a honest one :)

        Being Italian I have seen, in many US site, my country being insulted with the cheap and easy “Everything Italian is Mafia-Related” thing (I remember a site, in which I came throught Mommysh, in which a mother didn’t want to give her daughter an Italian name because she wanted “nothing to relate her with mafia”. True words. Ouch.)
        And I didn’t say a thing. I know that some people make the parallel in their mind.
        Sadly, it is something my country is famous for.

        Why do I tell this? Because it is the same. I (and many other) don’t know much about midwifery in Australia, save one case that made the headling. In the same way, how many people in the World know how much we Italian fight with Mafia?

        I am sorry for the good, honest midwife in Australia but, like us Italian, they have been spoiled by a rotten apple.

        I reiterate: it was an honest question.

      • Katie

        T, all midwives in Australia are registered nurses, they assist in hospital births (often being the ones to birth the child, not the doctor), birthing centre births and homebirths.

        As with any industry in any country, occasionally someone comes along who is sub par, or has their own beliefs. Lisa Barrett was one of those people. Welcome to life, where this stuff happens.

      • T.

        Uhm.
        Provocative question, anybody? :(

        I expected something like:

        “Yes, x% midwife in Australia had supported Lisa Barrett, but as you can see the vast majority didn’t. And this is what had been done to avoid such aberration from happening again (insert link or explanation)”

        *double sigh*

        I am not going to say anything more because, sadly, some sarcasm had degenerated the topic. If I had known that would be the case, I would have post the numbers to begin with.

        (Yes, I am being a little bit sarcastic here :P And, please, believe me: there is a difference between being sarcastic and being a Troll.)

        Thanks everybody for the discussion.

    • Katia

      I don’t see the appeal. I had a female obgyn and delivery nurses are very warm, and now how to teach you to breastfeed. I would just prefer to trust a doctor. I’m I’m Canada too so it would be free. One dental hygenist who I had was over 40 and planning to have a home birth with a midwife, I am still shocked shed take that risk. One friend went the midwife route and The midwife did not know the position of the baby, resulting in 7 hours of unmedicated labour before a c~section

    • Andrea

      Lots of midwives are nurses with a specialization in obstetrics, so they are very educated. The ones I know practiced with ob/gyn and delivered babies in the hospital. I’ve had both my babies in the hospital assisted by midwives. They were wonderful and know exactly what they are doing. Much better than a rushed doctor that wants to force you to give birth in time for his tee off.

      • T.

        Far from me to say anything about choice that, in the end, can hurt noone but yourself, but can I say that I find the insistence of american on the connection between doctors and golf to be endlessy amusing?
        Not just OB, mind you. All doctors.

        No MD that I know around here play golf. Seeing as much American talk about it it must be taught in the US together with anathomy.

      • Andrea

        It was just an expression girl, lighten up.

        I meant that doctors here don’t spend too much time with you. It’s very often the nurses that are there with you for the hours it takes to deliver a baby. I was personally almost bullied into having an induction with my first baby because it was beginning of July and my doctor didn’t want to deliver my baby on July 4th (a holiday here in the USA). I regretted tremendously. I refused to have an induction with my 2nd unless they could prove to me it was a medical necessity. Of course it wasn’t. I deliver my 2nd baby by a midwife in the hospital in no time and she was wonderful, supportive, attentive, and kind. I couldn’t wish for a better experience. I never had more children, but unless there is a chance of great complications, I would never choose to be delivered by an OB

      • T.

        I am sorry, it is just that, for me, there is no other reason for childbirth that… giving birth to a child. Healthy if at all possible.

        Honestly, I don’t care if the person who take care of my health is supportive. I care if she/he is good at what she/he does.
        I can get my emotional rassurance elsewhere, but I can’t get medical care from somebody who is not a doctor.
        ANY attempt to ditch me from a certified doc to… everything else will be meet with screan and outrage.

        But again… I am not mother material, thanks God. That might be it.

    • T.

      I don’t understand why somebody, anybody, would want somebody who is not a doctor to take care of their health.

      But I don’t see the allure of children to begin with :)

      • CW

        In the last two obstetrical clinics that I’ve been a patient of, the OB’s take care of the high-risk patients (older moms, those expecting multiples, those with breech babies, those with previous C-sections, etc.) and the nurse-midwives take care of the low-risk patients. All deliveries are in hospitals with an OB available to perform an emergency c-section if necessary. If you’re a low-risk patient, having an OB deliver your baby is really overkill. A nurse-midwife has the training and experience needed for a routine natural delivery. Let the OB’s focus on the moms who really need someone who is a trained surgeon.

      • T.

        Didn’t know there weren’r enough Ob/gyn in the US… but with the number of people sueing them because they haven’t made a c-section at the slightest sign of trouble and setting for million, I guess it make sense that less people would chose that track.

    • Janna

      I opted for a midwife for my pregnancy so the focus would be on me and more natural ways to deal with a twin pregnancy. My midwife worked in conjunction with her groups that included another midwife and 5 OBGYNs. When I began to have complications she brought in her colleagues and we worked together to deliver my twins safely. I will go back to her again for my next pregnancy even though I will have to have a c-section. She will provide the routine care and an OBGYN will do the surgery.

      A midwife is just as educated, at least in WI, as an MD, but focuses on the care of the patient, not the medicine. She also had more time to really listen to me and my concerns. The one time I had to see an OBGYN in her group they just wanted to get in and get out because they were overburdened with patients and I wasn’t a priority at the time.

    • Veronique

      If I could have had a midwife, I would have for sure!!!! In Montreal, there’s actually a shortage of midwives and you need to get onto a wait list in order to have one! The same thing for birthing centers!

      My compromise was to hire a doula, which is 80% reimbursed by my private healthcare insurance. She’ll be there to help me deal with the physical pain and exhaustion of labour, help me communicate with the hospital staff about my birthing plan, and make sure that all interventions are what are safest and most needed in my case. I want this because I’m giving birth in a university hospital that is known for their gung-ho approach to any and all medical interventions, which if they can safely be avoided, I would prefer that.

      Of course, I am flexible, and will do what is best for the baby so I’m not completely refusing medical interventions, I just want to be able to slow down the process safely, and have someone by my side who is highly knowledgeable and will be able to support me through this :)

      • Terri Coles

        We have more demand than midwives in Toronto as well, and wait lists. I went with an OB for a few different reasons, but also have opted for a doula.

    • Melissa

      Hi Terri, I just wanted to let you know about a difference in American and Canadian midwives that you seem to be unaware of. I understand that ALL midwives in Canada (and all other first world countries, such as the Netherlands) must be nurse midwives, meaning they have gone to nursing school and may have additional post-graduate training specific to midwifery. This is also true of nurse midwives in the US – usually known as Certified Nurs Midwives, or CNMs. They are actually required to have a Master’s Degree in Midwifery to be called a CNM.

      However, the type of midwives who predominately attend homebirths are lay midwives, or direct entry midwives. These are the ones you are referring to when you say they are illegal in North Carolina and Alabama. If licensed and legal, they are usally known as Certified Professional Midwives (CPMs). There are several paths of entry into this profession, but many of these CPMs receive no actual medical training. Many of them are apprenticed into the profession and after attending so many births (you could look it up, but the number is woefully small) they can take an exam and call themself a midwife. This the reason why they are illegal in some states. Also, from what I understand it’s very rare for these types of midwives to have collaborative relationships with OBs or hospitals, and as such are basically “out there on their own” overseeing births with little regulation or accountability.

      I think this is a very important distinction to make. Representing the two types of midwives as equals does a disservice to CNMs who have actually gone the distance and gotten the education to safely help women achieve their goals during childbirth.

      • Terri Coles

        Thank you for the extra information!

    • Amanda

      I don’t understand the midwife as a status symbol…midwives are way less expensive than typical hospital births! My friend had her baby in the hospital and paid over $10,000…while I had a home birth with a lay midwife and only paid $3000.

      • T.

        Yes, it is the difference between:
        Years of -costly- medical training
        The price of insurance (docs got them, lay midwifes often don’t).

      • T.

        Yes it is the difference between:
        -Years of -costly- medical training VS no training (if lay midwife, probably she doesn’t have any)
        -Cost of insurance VS no insurance (midwifes don’t have to have one)
        -Cost of a setting in which, in case things go wrong, you have backup VS nothing

        It is all a matter of what you want to spend for, really :)

      • CW

        Insurance doesn’t always pay for midwives, however. Mine only covered my midwife because she delivers in a hospital. If I had wanted a homebirth, I would’ve had to pay the entire cost out-of-pocket vs. only around $800 total in cost-shares.

      • CW

        No training? Sure, if you hire some unlicensed “lay” midwife. CNM’s have a B.S.N. and a specialized M.S.N. in midwifery, so that’s 6-7 years of education plus they have to pass a licensing exam. Many CNM’s work in obstetrical clinics with OB’s so there is a M.D. on the premises if a low-risk patient experiences a complication with her pregnancy or delivery.

      • Melissa

        @CW – In Amanda’s original comment she specified that she hired a lay midwife. I think this is what T is referring to in her comment.

      • Mrs. Lynn

        I was confused too. Midwives are far cheaper than hospitals. And my insurance covers them too!

    • T.

      If I might add… I am Italian and we have one of the highest rate of C-Section in the world.

      Also:

      http://www.guardian.co.uk/science/2012/jun/21/medical-research-health

      HUZZAH for interventions!

    • Nica

      Just gave birth with an OB and midwife. It was really the best of both worlds. As it ended up, the midwife provided all my prenatal care since I was a low-risk pregnancy and a healthy mom. She was on-call when I went into labor and provided labor support. She was off call about 20 minutes before I delivered so my OB did the actual delivery. It was great having both professionals overseeing my pregnancy. If i were to have another child (very unlikely), I’d go the same route for care.

    • Another Steph

      Sorry, I just didn’t have time to find the results of the poll where they asked every single midwife in Australia what they thought of this one particular case – one single bad example in the millions of midwife assisted births that have taken place throughout Australia.

      Australian midwives are amazing. Overworked, underpaid, but so enthusiastic about their work. My birth was administered to solely by midwives, there were complications that required a doctor to intervene straight afterwards but up until that point, and for the entire week I spend in hospital afterwards, I felt completely safe and relaxed knowing I was in the care of such knowledgable professionals.

      So yes, it’s a little galling to see someone completely diminish the work of these wonderful nurses by generalising an entire professional based on the actions of one person.

      • Another Steph

        Fail. ^ was supposed to go under the first comment.

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