(% 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

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

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.