Midwifery Care at Hospitals Associated with Fewer Medical Interventions

AMHERST — In a new, hospital-level analysis by health-policy researcher Laura Attanasio at UMass Amherst and Katy Kozhimannnil at the University of Minnesota School of Public Health, they report that women who gave birth at hospitals that had a larger percentage of midwife-attended births were less likely to have two specific medical interventions, cesarean delivery and episiotomy.

Attanasio, an assistant professor of Health Policy and Management at UMass Amherst’s School of Public Health and Health Sciences, explains that a growing body of research at the individual level has shown that, compared to women cared for by physicians, women considered at low risk for complications in childbirth who receive care from midwives have good outcomes that include lower use of interventions such as cesarean delivery.

The researchers analyzed hospital-level data reported in New York state over one year. Details appear in the current Journal of Midwifery & Women’s Health. Their study analyzes the experiences of individual women; an accompanying policy brief looks at hospital rates of medical interventions at the time of childbirth.

The authors say their findings raise the possibility that greater access to midwifery care, which is low in the U.S., might enhance perinatal care and lower costs for low-risk women. In 2014, the year of the study, Attanasio and Kozhimannil point out that midwives attended just 9{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of U.S. births, compared to more than 66{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} in other western countries such as Australia, France, and the U.K. 

“More midwife-attended births may be correlated with fewer obstetric procedures, which could lower costs without lowering the quality of care,” they note. “This raises the possibility of improving value in maternity care through greater access to midwifery care for childbearing women in the United States.”

Several states are considering expanding midwives’ scope of practice as New York did in 2010 for certified nurse midwives, Attanasio said. “I hope that this work contributes to the evidence related to promoting the quality and value in maternity care that midwives can bring. A number of studies have shown that expanding their scope of practice and giving midwives more autonomy can increase women’s access to midwifery care.”