Mothers, Midwifery, and Medicine

Authored by Shruti Nagpal

Art by Jenny Li

4.3 trillion dollars. 

That’s how much the United States spent on healthcare in 2021. That’s about $12,900 per person, more than double the amount spent by most other developed countries across the globe [1]. 

With such great investments into the healthcare system, it’s natural to assume that the United States has phenomenal healthcare, with low mortality rates, minimal sick patients, and lots of happy people. However, this is quite far from the truth. In fact, the United States is and has been in the midst of a maternal mortality crisis - a crisis that often falls short of the public eye [2]. 

Maternal mortality is defined as the death of women during or following childbirth due to a number of complications, including severe bleeding, infections, and hypertension [2]. It is often exacerbated by various social determinants of health, lack of accessibility to healthcare facilities, and disconnect within the healthcare system [2]. 

In the United States, the maternal mortality rate increased from 20.1% to 23.8% between 2019 and 2020– a significant rise that cannot even be attributed to COVID-19 [3]. This increase was especially prominent among Black women, who were reported to have 55.3 maternal deaths per 100,000 births in 2020: more than any other nation, let alone race [3]. 

These findings are surprising to many, considering the United States’s wealth and monetary healthcare contributions. That being said, it is important to find out where exactly the increasing rate of maternal mortality originates from.

One critical and often overlooked explanation is the lack of midwives involved in the childbearing process. According to the World Health Organization, “midwifery is defined as ‘skilled, knowledgeable and compassionate care for childbearing women, newborn infants and families across the continuum from pre-pregnancy, pregnancy, birth, postpartum and the early weeks of life’” [2]. Midwives are healthcare providers that specialize in obstetric and gynecologic services, primarily prenatal appointments and routine pregnancy monitoring, ultrasounds and prenatal blood work, birth and newborn care, and postpartum care.

One of the primary differences between midwives and physicians is that they have increased involvement in the pre-pregnancy period for pregnant individuals. Midwives help ensure healthy pregnancy as early as the first trimester and provide critical education on nutrition, lactation, fertility, and several other components of reproductive health [5]. In focusing on the well-being of pregnant individuals before childbirth, midwives can help reduce complications during childbirth. Studies in the United States have found that midwifery care is linked to lower rates of medical intervention in childbirth, specifically cesarean delivery [6]. Midwives also play a critical role in care after childbirth, helping with postpartum checkups to ensure the health of mothers [5].

Midwives are integral to a healthy pregnancy and childbirth, but they aren’t more common in healthcare settings in the United States, a conundrum that can only be explained by understanding the history of midwives. 

Let’s turn back to the late 1800s. Around this time, anesthesia was readily being used in the hospital setting, and it reduced some of the discomforts felt in childbirth. This innovation and an understanding of germ theory improved maternity care significantly, which meant that midwives were no longer required in hospitals, almost wiping out the profession entirely by 1960 [7]. OB-GYNs at the time, who were primarily male, also supported the removal of midwives from healthcare settings. Even though studies highlight the importance of midwives within the healthcare system today, only one in eight births is supervised by a midwife [7]. According to Scientific American, one explanation for this is that several states choose not to recognize midwives as legitimate practitioners and others legally limit their roles and responsibilities [7]. 

Since midwives are so important to ensuring healthy pregnancy and childbirth, what can be done to increase their involvement?

One of the first steps of action is to advocate for national, universal standards for midwifery. These standards should mandate the presence of midwives in healthcare settings for all low-risk births. Funding should also be allocated to community health organizations that can send midwives to communities composed primarily of marginalized groups with higher rates of maternal mortality, such as Black communities. Another plan of action is to advocate for private insurance companies to cover the costs associated with midwifery that are currently imposed on patients who do receive such services. 

Maternal mortality is a critical issue in the United States, and midwives are an integral part of the solution. Let’s help ensure that every one of the 4.3 trillion dollars invested in healthcare counts and truly improves the lives of people, including mothers. 

References

1. McGough, M., Telesford, I., et al. (February 9, 2023). How does health spending in the U.S. compare to other countries? Retrieved from https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/#Health%20consumption%20expenditures%20per%20capita,%20U.S.%20dollars,%20PPP%20adjusted,%202021%20or%20nearest%20year 

2. World Health Organization. (February 22, 2023). Maternal mortality. Retrieved from https://www.who.int/news-room/fact-sheets/detail/maternal-mortality 

3. Gunja, M., Gumas, E., Williams, R. (December 1, 2022). The U.S. Maternal Mortality Crisis Continues to Worsen: An International Comparison. Retrieved from https://www.commonwealthfund.org/blog/2022/us-maternal-mortality-crisis-continues-worsen-international-comparison 

4. World Health Organization. (2023). Midwifery education and care. Retrieved from https://www.who.int/teams/maternal-newborn-child-adolescent-health-and-ageing/maternal-health/midwifery/maternal-health-83-percent-midwifery-care 

5. Cleveland Clinic. (2023). Midwife. Retrieved from https://my.clevelandclinic.org/health/articles/22648-midwife 

6. Grey, Heather. (December 5, 2020). Midwives May Help Save the Lives of Millions of Women. Retrieved from https://www.healthline.com/health-news/midwives-may-help-save-the-lives-of-millions-of-women#Midwifery-in-the-United-States 

7. Scientific American. (February 1, 2019). The U.S. Needs More Midwives for Better Maternity Care. Retrieved from https://www.scientificamerican.com/article/the-u-s-needs-more-midwives-for-better-maternity-care/#:~:text=Obstetricians%20helped%20to%20bar%20midwives,doctors%20to%20supervise%20uncomplicated%20deliveries.