Access to modern obstetrical care has no doubt saved countless lives.
C-sections can and do save lives.
However, when c-sections are performed unnecessarily, they can also pose serious morbidity and mortality risks, which outweigh potential benefits.
For this reason, doctors, researchers and public health officials have been researching ways to reduce c-section rates among hospital births.
What’s their solution? Hospital based midwifery care.
If a c-section is the safest way to get an individual mother and baby safely through birth, then it’s the best decision for that mother-baby pair.
Currently, however, about one in three births in the United States ends in a c-section. Research and evidence from the World Health Organisation (WHO) support a c-section rate of about 10-15%. Potentially, more than half of all c-sections are performed unnecessarily.
3 Reasons Hospital Midwives Might Equal Fewer C-Sections
Time and time again, current research shows midwifery care to be a potential solution to our c-section crisis.
Why? Because midwifery-led models provide evidence-based care and knowledge of normal physiological birth, reducing the risk of unnecessary interventions.
How Can Hospital Midwives Reduce C-Section Rates?
Health policy researcher, Laura Attanasio (University of Massachusetts Amherst), and Katy Kozhimannil (University of Minnesota) conducted a hospital level analysis that found the higher the percentage of births attended by midwives, the lower the hospital’s c-section rate.
They also found there were fewer episiotomies in hospitals where midwives attended more births.
Attanasio and Kozhimannil looked at 126 New York hospitals. Of those hospitals:
- 25% had no midwives
- Around 50% had midwives, but those midwives attended less than 15% of births
- 7% of the hospitals had midwives who attended more than four out of every 10 births.
The study, which was published in the current issue of Journal of Midwifery & Women's Health, took place in 2014. During that year, just 9% of US births were attended by midwives. This is extremely low when compared with the situation in other developed countries, such as France and the UK, where midwives attend around 66% of births.
The US has some of the worst maternal infant outcomes among western countries. This research suggested the lack of midwifery care could have played a significant role.
Why would midwifery care lower c-section rates?
Here are 3 reasons we see fewer c-sections when women have midwifery care:
#1: The Midwifery Model Of Care Offers Continuity Of Care
Every midwife, just like every doctor, practises in a unique way. However, a midwifery model of care emphasises continuity of care.
Sometimes this might mean one or two midwives provide your care for the duration of your pregnancy, labour, birth and postpartum period.
In some practices, you might not have the traditional midwifery model of care. However, even when a midwife attends only the birth, there’s a level of continuity of care for the duration of your labour.
A midwife’s training encourages a focus on the mother as a whole being, and recognises the impact birth will have on the mother-baby pair. This impact has far-reaching consequences for physical and mental wellbeing.
Continuity of care, whether long-term or brief, might be the key to preventative care (e.g. good prenatal nutrition or encouraging upright positions during labour). It might also catch red flags for complications as early as possible.
You might be surprised to know that research, based on outcomes, shows midwives provide care equal to, and in some circumstances better, than that provided by physicians.
Be sure to read Midwives And Nurses Can Provide Equal Or Better Care Than Physicians – WHO Report to learn more.
#2: Midwives Use Fewer Birth Interventions
Modern obstetrical care can save lives. However, anything that interferes with normal birth physiology has its risks. For this reason, it’s important to weigh up the benefits of intervention against its risks, on an individual basis.
For example, a medical induction carries risks. When done electively (meaning without medical necessity) most research shows the benefits don't outweigh the risks. For a woman experiencing preeclampsia, however, the benefit of baby being born to resolve the preeclampsia outweighs potential risks.
It’s important we have interventions when we need them. If they are used unnecessarily, however, mothers and babies can fall into the cascade of intervention. What seems to be a minor intervention has the potential to lead to more interventions, due to side effects, and sometimes might end in a c-section.
Statistically, midwives use fewer interventions. Research shows women who give birth with a midwife are:
- Less likely to use an epidural
- Unlikely to have an episiotomy
- At a lower risk of needing a vacuum or forceps assisted birth
- More likely to have a spontaneous vaginal birth, meaning they’re less likely to have a medical induction.
More spontaneous vaginal births without epidurals could be part of the reason midwife-attended births are less likely to end in c-section.
Be sure to read Midwives Getting Better Results For Birthing Women to learn more about the advantages of midwifery care.
#3: Midwives Are Trained In Normal Physiological Birth
Birth is a complex, hormonally charged, physiological process. Yet, in most situations, when we don’t interfere too much, birth unfolds quite well. It’s a normal bodily function.
Certainly, things can deviate from normal, even in the best of circumstances. In those situations it’s imperative we have access to modern obstetrical care.
However, our ‘simple’ interventions – such as routine IV, position restrictions, Pitocin/Syntocinon – can sometimes cause an otherwise low risk birth to become higher risk.
One big difference between obstetrician training and midwifery training is how practitioners are taught to view and support mother-baby pairs during labour and birth.
Obstetricians are generally taught how to manage birth. They’re often trained to view birth as a medical event which could go wrong at any time. They see active management – such as continuous fetal monitoring, and administering Pitocin if things progress more slowly than expected – as being necessary for all risk levels.
Midwives are taught to trust normal physiological birth, and also have the knowledge to catch any signs intervention might be needed. They’re taught how to facilitate physiological birth, by encouraging active and upright birth, for example, and by helping women to be active participants in their baby’s birth, and to feel not only physically but also emotionally safe. They’re also taught to make use of interventions only when they are medically necessary.
Be sure to read 6 Reasons Why We Love Midwives to learn why birthing women and birth professionals love midwifery care.
Is Our C-Section Rate Really Dangerous?
Perhaps you’ve had a c-section, or maybe several of your friends have had one (or a few). You might be wondering why c-section rates even matter.
Certainly, modern surgeries are much safer than they used to be. We know about infection prevention, anaesthesia is safer than ever, and we’re constantly bringing new technology into the operating room.
However, c-sections are still major abdominal surgeries. We’re also still learning about the complexities of normal physiological birth and the impact it has on both mother and baby. Deviating from our biological norms isn’t without risk.
One in three births ends in c-section. From a public health perspective, that means higher rates of maternal and infant morbidity and mortality than if we had an expected c-section rate of no more than 10-15%. It also means higher healthcare costs.
On an individual level, it means more than half of all women who gave birth via c-section might have had unnecessary c-sections which put them at risk for infections, blood loss, and increased their baby’s risk of needing time in the NICU. It might also have left them feeling traumatised, or affected their future fertility and family planning.
We are very fortunate to live at a time when c-sections are available when needed. However, mothers and babies are put at risk when c-sections are performed too often.
Be sure to read Doctor Nails Reasons Behind 500% C-Section Increase Since The 70s and The Secret Weapon To These Doctors’ 12% C-Section Rate to learn more about our rising c-section rates and how we’re working to reduce them.