Many industrialized countries, with better health outcomes than the U.S., utilize midwives and the midwifery model of care for a large and growing number of their citizens. This model of care emphasizes specific required characteristics of maternity care, rather than a particular type of provider. The Midwives Model of CareTM includes four distinct care points that provide a “woman-centered model of care that has been proven to reduce the incidence of birth injury, trauma, and cesarean section” among other meaningful positive health outcomes (CFM, n.d.). This model of care contrasts sharply from the obstetrical model of care, and interestingly, though these titles depict a provider-type, they actually align more closely with a specific care location. The obstetric model of care is what is employed most commonly in the hospital setting and the midwifery model of care is the standard for community-based birth providers (Citizens for Midwifery [CFM], n.d.). As demand for community-based birth care increases, more providers trained in the midwifery model of care will be needed.
While skilled physicians will always be an important component of maternal health care services, it is clear that solutions are needed beyond simply expanding delivery of the status quo. Instead, if family-practice physicians, perinatologists, OBGYNs, and midwives could work together to provide care to all birthing people regardless of care location, some of these gaps could be bridged. Indeed, many countries with far better outcomes have successfully accomplished exactly this (Munabi-Babigumira, Glenton, Lewin, Fretheim, & Nabudere, 2017).
Britain’s National Health Service issued a public statement in 2014 emphasizing the importance of access to community-based birth: it advised healthy women that “It was safer to have their babies at home, or in a birth center, than in a hospital” (Bennhold & Saint Louis, 2014). One of the reasons why this recommendation is possible in England, and not yet in the U.S., is because of the integration and interprofessional training in community-based birth (CBB) that allows CBB attendants to transfer women to hospital for the low percentage that need it (Royal College of Midwives, 2018). Considering other European countries, “In Sweden, Norway and France, midwives oversee most expectant and new mothers, enabling obstetricians to concentrate on high-risk births. In Canada and New Zealand, midwives are so highly valued that they’re brought in to manage complex cases that need special attention” (Martin, 2018). Even in the U.S., though studies are infrequent, a study published in 2018 evaluating key measures of maternal and neonatal health, state-by-state relative to the degree of autonomy and integration midwives had in those states, found significant differences among states (Vedam et al, 2018; Cheyney & Hamilton, 2018). “In communities that are most at risk for adverse outcomes, increased access to midwives who can work as part of the healthcare system may improve both outcomes and the mothers’ experience,” said lead researcher Saraswathi Vedam (Martin, 2018).
To download a Midwives Model of Care brochure created by Citizens for Midwifery, click below
To download the WHO (9 module) 'Strengthening Midwifery Toolkit' Click here
Bennhold, K. & Saint Louis, C. (2014, December 4). British regulator urges home births over hospitals for uncomplicated pregnancies. The New York Times. Retrieved from https://www.nytimes.com/2014/12/04/world/british-regulator-urges-home-births-over-hospitals-for-uncomplicated-pregnancies.html
Cheyney, M., & Hamilton, L. (2018, February 21). Midwifery linked to better birth outcomes in state-by-state report cards. Oregon State University Newsroom. Retrieved from https://today.oregonstate.edu/news/midwifery-linked-better-birth-outcomes-state-state-report-cards
Citizens for Midwifery. (n. d.) Midwives model of care. Retrieved from http://cfmidwifery.org/mmoc/define.aspx
Martin, N. (2018). A larger role for midwives could improve deficient US care for mothers and babies. ProPublica. Retrieved from, https://www.propublica.org/article/midwives-study-maternal-neonatal-care
Munabi-Babigumira, S., Glenton, C., Lewin, S., Fretheim, A. & Nabudere, H. (2017). Factors that influence the provision of intrapartum and postnatal care by skilled birth attendants in low- and middle-income countries: a qualitative evidence synthesis. Cochrane Database Systematic Review. 2017(11), 1-132. http://dx.doi.org/10.1002/14651858.CD011558.pub2
Royal College of Midwives. (2018). Apprenticeship Guide [PDF file]. Retrieved from file:///C:/Users/augus/Dropbox/Bastyr/IP/RCM%20Apprenticeship%20Guide%202018%20A5%2040pp_4%20(3)%20final.pdf
Royal Dutch Organization of Midwives (KNOV). (2012). Midwifery in the Netherlands 2012 [PDF file]. Retrieved from: http://www.europeanmidwives.com/upload/filemanager/content-galleries/national-guidelines/KNOV_Midwifery_in_the_Netherlands_20121112.pdf
Vedam, S., Stoll, K., MacDorman, M., Declercq, E., Cramer, R., Cheyney, M., et al. (2018). Mapping integration of midwives across the United States: Impact on access, equity, and outcomes. PLOS ONE 13(2): e0192523. Retrieved from: https://doi.org/10.1371/journal.pone.0192523