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Little Known Facts

Facts From All Over The World

Why aren’t more women in this country experiencing the proven advantages of pregnancy and birth care offered by midwives?
Because birth is big business. Each time a woman chooses to utilize a midwife for her pregnancy and birth care, a doctor and possibly a hospital have lost a potential consumer.

As much as women have been told birth outside of the hospital is unsafe, those statements are being proven untrue for a low-risk pregnancy, and it is up to the women in the United States to turn the tide back to a kind of care that is woman and family focused. It is our responsibility to educate ourselves on what is best for us and our babies instead of blindly accepting what is being told to us by people who have also accepted untruth as the way things are done.

Although certified nurse-midwives (CNMs), accredited by the American College of Nurse Midwives (ACNM), are now licensed in all fifty states, in order to practice in the hospital, they are required to practice under the strict supervision of a physician, often limiting their ability to provide maternity care that is significantly different than that typically offered by an obstetrician.

Bruce Flamm, MD, OB-GYN wrote in Midwifery Today that “Nurse-midwives seem to be moving more toward the obstetrical philosophies, assimilating the new technologies and many actually view themselves as part of the medical establishment.” One nurse-midwife quoted in Reclaiming our Health said that the arts of nursing and midwifery are “really quite different” and reported that what she learned in nursing school was “quite irrelevant” to attending births. “Nurse-midwife has the same ring to me as ballerina-carpenter,” she comments.

Healthcare Spending

(% of GDP – CIA World Factbook 2009 – Actual CDP 2011) 

  1. Singapore 3.90% of $329.7 billion or $1,804 per capita
  2. Iceland 4.20% of $14.06 billion or $1,851 per capita
  3. Italy 5.10% of $2.19 trillion or $1,847 per capita
  4. Sweden 9.90% of $538.13 billion or $5,638 per capita
  5. USA 16.20% of $15.09 trillion or $7,863 per capita

2001, WHO Statistics:

  1. 100% of countries providing universal prenatal care have lower infant mortality rates than the US.
  2. Percent of US births attended by midwives: 4%
  3. Percent of European births attended by midwives: 75%
  4. Number of European countries (Great Britain, France, Germany, Netherlands, Belgium, Denmark, Sweden Norway, and Finland – all with over 75% of midwife-attended births) with higher perinatal mortality rates than the US: 0%
  5. Health care cost savings if midwifery care were utilized for 75% of US births: $8.5/billion/ year.
  6. Health care cost savings by bringing US cesarean section rate into compliance with WHO recommendations: $1.5 billion/year.
  7. Health care cost savings by extending midwifery care and de-medicalizing births in the US: $13-20 billion/year


 Induction of labor (only with oxytocin or prostaglandins)  2.1%  21%
 Stimulation of labor (only with oxytocin)  2.7%  18.9%
 Electronic fetal monitoring  9.6%  84.3%
 Episiotomy  2.1%  33%
 Vacuum Extraction  0.6%  5.5%
 Cesarean Section  3.7%  19%

Because a typical midwife-assisted package of prenatal and birth care costs thousands less than seeing a doctor, Frank Oski, MD, director of pediatrics at John Hopkins University School of Medicine, has estimated that the United States could save more than ten billion dollars per year in health-care costs by utilizing midwives as primary care givers in pregnancy and childbirth.

In the countries with the best pregnancy outcomes, midwives are the primary providers of care to pregnant women.

The latest statistics from 2013 on a  hospital birth are as follows:

  • Uncomplicated vaginal birth = $7,000
  • Complicated vaginal birth = $9,000
  • Uncomplicated C-Section = $12,000
  • Complicated C-Section = $16,000

These prices are just for the hospital stay, and do not include doctor’s fees for being at the birth which start at $1,500, and also does not include prenatal care or newborn care.

A study by Klaus and Kennel that appeared in JAMA (Kennell J, Klaus M, McGrath S, et al. Continuous Emotional Support during Labor in a US Hospital: A Randomized Controlled Trial. JAMA 1991; 265:2197-201), prove that the single factor that increases the chances for a healthy outcome for both mother and baby is uninterrupted 1:1 care during labor by a skilled caregiver. That situation is guaranteed in a home birth. These days, it’s virtually impossible to achieve that level of care in hospitals.

According to the Midwives’ Alliance of North America, in the five nations with the world’s lowest infant mortality and lowest rates of technological intervention, midwives attend seventy percent of all births without a physician in the birth room.

Understanding the potential danger in the overuse of childbirth technology, the World Health Organization has repeatedly implored the U.S. medical authorities to return to a midwife-based system of maternity care as one way to help reduce our scandalously high mortality rates Mothering, Jan/Feb, 1990

Midwives, in fact, still attend most of the births around the globe. Physicians, in spite of their advanced training and surgical specialties, have never been proven to be better childbirth attendants than midwives. And no research has been done that proves hospitals to be the safest places in which to give birth.

A six-year study done by the Texas Department of Health for the years 1983-1989 revealed that the infant mortality rate for non-nurse midwives attending homebirths was 1.9 per 1,000 compared with the doctors’ rate of 5.7 per 1,000. Certified nurse midwives’ mortality rate was 1 per 1,000 and “other” attendants accounted for 10.2 deaths per 1,000 live births (Texas Lay Midwifery Program, Six Year Report, 1983-1989, Bernstein & Bryant, Appendix VIIIf, Texas Department of Health, 1100 West 49th St., Austin, TX 78756-3199.  Labor Pains: Modern Midwives and Homebirth, Sullivan & Weitz, 1988.)

Wagner states that in Europe midwives far outnumber physicians: “In no European country do obstetricians provide the primary health care for most women with normal pregnancy and birth.” He states that the U.S. has the highest obstetrical intervention rates as well as a serious problem with malpractice suits and concludes that a strong, independent midwifery service in the U.S. would be a most important counterbalance to the present situation.

Bruce Flamm, MD, OB-GYN, says that “obstetricians have been taught that pregnancy and labor are disasters waiting to happen.”

Paul Lewis, Midwife and Academic Head of Midwifery at the University of Bournemouth, England, UK, sees this mischaracterization of childbirth as a risk factor unto itself. “I do recognize the need for medical involvement when women have high-risk pregnancies or when serious complications occur. However, we know from the research evidence that if low-risk women are cared for alongside high-risk women, that the former soon have applied to them the strictures intended to safeguard the latter. The problem with this approach is that such strictures carry risks in themselves and the complications of such treatments usually result in low-risk women becoming high risk.”

It is estimated that 60 million women give birth outside health facilities and 52 million births occur without a skilled birth attendant (midwife, nurse or physician) every year.  While coverage of skilled birth attendance is approaching 100 percent in most industrialized countries, it remains less than 50 percent for most countries in South Asia and sub-Saharan Africa. Given their current rate of less than 0.5 percent increase in skilled birth attendance per year, fewer than half the births in these regions will be attended by a skilled birth attendant by 2015.

Sources: UNICEF. State of the World’s Children 2009. New York: UNICEF, 2009.
Ronsmans C, Graham WJ on behalf of The Lancet Maternal Survival Series steering group. Maternal Mortality: who, when, where, and why. Lancet 2006; 368: 1189–1200.
Lawn JE, Kinney M, Lee ACC, et al. Reducing intrapartumrelated deaths: Can the health system deliver. Intl Journal of Gynecology and Obstetrics 2009;107: S123–S142.

I found …that wherever a city, a county, a region, or a nation had developed a system of maternal care which was firmly based on a body of trained, licensed, regulated, and respected midwives (especially when the midwives worked in close and cordial co-operation with doctors) the standard of maternal care was at its highest and maternal mortality was at its lowest. I cannot think of an exception to that rule… Irvine Loudon, 1992

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