Midwifery in the USA

When I think about the difference between maternity care in America and abroad, a few things come to mind: The insignificance of midwifery care in the United States, and the medicalization of maternity care in the United States.

Midwives attended only 8% of all births in the United States in 2003 (Center for Disease Control and Prevention [CDC], 2006). Most births in America are attended by surgeons: Highly trained, specialized medical professionals. Some believe this is akin to cutting butter with a chainsaw. The medical management of pregnancy, labor and delivery is routine in the United States. The focus is on pathology: detecting it and treating it. And, a pregnancy cannot be labeled as “normal” until after it is over. The medical model is not designed to treat healthy people, which is what the vast majority of pregnant women are: Healthy, normal women undergoing the normal physiological process of pregnancy. Of the developed countries, only the United States and Canada rely on specialized surgeons to treat their low risk, healthy pregnant patients routinely (Wagner, 1998) In contrast to the care physicians provide, midwives’ care of women focuses on the physiologic normalcy of pregnancy, rather than the potential pathology (Kennedy & Shannon, 2004). Midwifery care is well-suited to the healthy pregnant woman and involves less medical interventions and cesarean sections (Sakala & Corry, 2008). Despite American women having higher satisfaction from midwifery care and a reduction in interventions and cesarean sections, midwives still have no regular place in the American health care system (Rooks, 1997).

Center for Disease Control and Prevention. (2006). Quick Stats: Percentage of Births Attended by Midwives – United States, 2003.

Kennedy, H. & Shannon, M. (2004). Keeping birth normal: Research findings on midwifery care during childbirth. Journal of Obstetric, Gynecologic & Neonatal Nursing, 33 (5): 554-560.

Rooks, J. (1997). Midwifery and Childbirth in America. Temple University Press: Philadelphia, PA.

Sakala, C. & Corry, M. (2008). Evidence based maternity care: What it is and what it can achieve. Childbirth Connection: New York, NY.

Wagner, M. (1998). Midwifery in the industrialized world. Journal of the Society of Obstetricians and Gynaecologists of Canada, 20:1225–34.

World Health Organization. (2010). Trends in maternal mortality: 1990 to 2008, Estimates

developed by WHO, UNICEF, UNFPA and The World Bank, Annex 1. 2010