Midwives and Homebirth

      In 1900 half of all Americans were born into the hands of a midwife, at home. Early studies comparing the birth outcomes of physicians versus midwives showed that midwives had fewer maternal and infant loses than the doctors. The United States had a very high percentage of maternal deaths compared to other countries.

     Reports done by the White House Conference on Child Health and Protection, the national Committee on the Costs of Medical Care, and the New York Academy of Medicine in the 1930's all concluded that midwives were safer than physicians. These reports chastised doctors for their frequency of interventions which led to problems. Many physicians, in response to the findings of the reports, placed the blame on the midwives claiming that midwives were "ignorant", "dirty", untrained and a threat to the safety of childbearing women. Medical journals and popular magazines contained many articles bashing midwives and blaming them for the nations appalling maternal mortality and infant mortality rates. Many physicians and public health advocates spoke up for the midwives and their excellent statistics, but the prestige of the anti-midwife physicians and the strong push to move births into the hospitals far over-shadowed their voices. This barrage of anti-midwife articles and propaganda continues today despite the lack of any studies or statistics to prove claims that physicians guarantee the safest outcomes or healthier babies or mothers.

What do the Statistics Show?

     Every valid study to date has shown that midwife-attended birth is at least as safe as physician-attended birth. Additionally, those who have a midwife-attended birth can expect to have fewer interventions of all kinds. In the early 1970's only 0.5% of all births were attended by midwives, but in 1980 this grew to 2.1% and in 1990 to 3.9%*. Infant mortality, IM, is one criteria for assessing safety of births. The most general use of the term includes infant deaths from birth to the first birthday. 1990 statistics from the Center for Disease Control show that Direct Entry Midwives had the lowest IM, half that of M.D.'s.


Attendant Live Births    IM Hospital    IM Birth Center    IM Home    IM
   MD 3,821,825    9.0  3,808,552    9.0   5,244    3.6    5,301    32.1
   DO 126,643    8.5    125,179    8.5     718    2.8      529    22.7
   CNM 148,730    4.6    148,730    4.6    5,711    3.5    3,430     5.8
   DEM   14,321    4.5       2,724    5.1    2,843    2.8    8,012     4.7

* Undoubtedly the number of births attended by midwives of all kinds is higher. In some states, nurse-midwives mainly work as employees under physicians and the insurance companies pay more for a physician attended birth. In order to receive the largest monetary compensation for births, and because the midwife is "under physician supervision" by law, the birth certificate is completed as through the doctor were attending, even if this was not the case. Additionally, in states where Direct Entry Midwives are not licensed or Direct Entry Midwifery is prohibited, many births either go unreported or are reported as unattended or the category of midwife is absent from the birth certificate. Statistics from Center for Disease Control, US Birth Cohort of 1990, Table 43, May 18, 1995.

Yvonne Lapp Cryns c 1995


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