This is consistent with what we are seeing in our practice as more surrogates are requesting deliveries by midwives as opposed to obstetricians:
In other developed nations, midwives are routinely tasked with bringing new life into the world. Not so in the U.S., where delivery is largely presided over by obstetricians. But a new study finds that midwives are getting busier, delivering 8.1% of the country’s babies in 2009 — a record high. Slice the data differently and the proportion rises even further. Consider vaginal births only — midwives don’t do cesarean sections — and the figure rises to 12.1%, or about one of every eight deliveries, according to statistics from the U.S. Centers for Disease Control and Prevention (CDC).
“If this trend continues, it will bring us more in line with the rest of the world in giving midwives a central role in prenatal care and birth,” says study author Eugene Declercq, professor of community health sciences at the Boston University School of Public Health. “Given that other countries have lower costs and better outcomes, it would be a positive thing for this country.”
The report, published Monday in the Journal of Midwifery & Women’s Health, analyzed two decades of CDC data that showed that a greater proportion of women are choosing to rely on midwives in what experts think is a direct reaction to rising rates of C-section births. Midwives approach birth differently than many physicians: they shy away from inducing labor in most situations, which can lead to a greater likelihood of cesarean delivery. Starting early in the prenatal period they may take a more holistic approach, emphasizing diet. In labor, they spend much more time in the delivery room, encouraging a woman to try different positions or to walk around to get labor moving. “They have more patience,” says Declercq.
A recent article in the New York Times noted that in certain chic city circles, midwives are becoming a must-have labor accessory:
“The perception of midwives has completely shifted,” said Dr. Jacques Moritz, director of the gynecology division at St. Luke’s-Roosevelt and a consulting obstetrician for three midwife practices. “It used to be just the hippies who wanted to go to midwives. Now it’s the women in the red-bottom shoes.”
And like any status symbol, a pecking order has emerged. Just as getting your toddler into the right preschool requires social maneuvering, getting into a boutique midwifery clinic has become competitive.
“We constantly have to turn women away,” said Sylvie Blaustein, the founder of Midwifery of Manhattan, a practice on West 58th Street that has its share of well-heeled clients. Opened in 2003, the practice now has six midwives on staff. “Because of the quality of care, we can only deliver about 20 babies a month.”
“It sounds bizarre,” Ms. Blaustein added, “but midwifery has become quote-unquote trendy.”
Part of that may be due to midwifery becoming more accepted by white mothers. Declercq’s study noted that in 1990, most midwife deliveries were to nonwhite mothers; by 2009, the figures had balanced out. There are also regional variations, with higher concentrations in the Northeast and West Coast. Some notable exceptions: in Georgia, midwives deliver about 18% of all vaginal births; New Mexico has the county’s highest rate, at 24% for all births. “Not surprisingly, they also have one of the lowest C-section rates in the country,” says Declercq.
In other parts of the country, some of the obstacles to expectant moms embracing midwives may stem from the confusion around their qualifications. An obstetrician is an obstetrician, but there are three categories of midwives: certified midwives (CM) are a small group who undergo training but are not as highly qualified as certified nurse midwives (CNM), who are registered nurses who’ve studied an additional two years to get a degree in midwifery. Certified professional midwives follow a different track altogether and attend mostly home births because — like certified midwives — their lack of nursing credentials mean they can’t get hospital privileges.
The actual number of CNM-assisted births has stayed the same over the years as the number of total births has dropped, which is why the proportion of midwife deliveries has increased. Doctors may not be too pleased with the data, since there’s long been a professional rivalry between the two camps. While in England a 1902 law put midwives in charge of maternity care, the U.S. enacted 1894 legislation in Massachusetts that made it illegal for midwives to practice without a medical license. From that point on, obstetricians have delivered most U.S. babies.
But in an article I wrote about home births, Dr. George Macones, an obstetrician at Washington University in St. Louis and chair of the American College of Obstetricians and Gynecologists’ committee on obstetric practice, singled out birthing centers as an option that more pregnant women should be able to access. Staffed by midwives, birthing centers in or near hospitals can provide a more peaceful delivery while still offering expert medical care should an emergency arise. “That’s the best of both worlds,” says Macones. “It’s a very nice, quiet, more natural experience, but if something happens you could literally be wheeled underground to the hospital.”
It is also one of the thornier issues we have to negotiate in our surrogacy arrangements. While an increasing number of surrogates are preferring the use of a midwife (and sometimes demanding that the delivery occur outside of a hospital), their Intended Parents haven’t quite warmed to the notion. So I strongly advise that this issue be broached early in the matching process as this might be a philosophical divide too large to bridge if the parties are so entrenched in their positions that they cannot agree upon the use of a midwife. Among the methods to reconcile these competing positions is to have the parties agree to the presence of a midwife, though under the direct supervision of an obstetrician who will be present at the birth. While some surrogates may still object to the involvement of an obstetrician, ultimately it is a fair compromise that addresses the concerns of all parties.