Every pregnant mother wants to choose the absolute best healthcare provider for her prenatal care and birth.
Each mother wants to ensure her baby comes safely earth side.
Surely that means picking the healthcare provider with the most years of medical education and access to the most cutting edge technology, right?
A World Health Organization report actually found otherwise.
In maternity care, and some other aspects of healthcare, midwives provide equal care and, in some areas, even outperform physicians. This is especially true for women experiencing low risk pregnancies.
In fact, some research even finds that utilising obstetricians for low-risk, and even some high risk situations, can increase the risk of certain interventions.
One of the goals of the World Health Organization is to make sure everyone has access to lifesaving medical care, as well as routine and preventative care. They seek ways to do this safely, as well as efficiently and affordably.
While the WHO looks at healthcare globally, their research findings apply in developed countries (US, Australia, the UK, etc) as well as developing countries.
How can a provider with less medical training provide equal, or even better, care? When it comes to birth, how could a provider with less training be a safer option?
Here are 3 things you should know about why midwives and nurses can provide safer care:
#1: Midwives And Nurses Receive High Quality And Focused Education
When some people hear the word ‘midwife', they think of an underqualified, self-trained birth attendant. Although the levels of education can vary, in the WHO study and other research, ‘midwife' describes an educated and qualified healthcare professional.
Training varies, but in many countries midwives are advanced practice nurses. They have bachelor’s or master’s degrees in midwifery care, or have a master’s in midwifery following a non-nurse bachelor’s degree. They receive in-depth academic education, as well as clinical training and experience before they can even sit for the exams to qualify as midwives.
Nurses also received academic and clinical education before they can sit for their licensing board exams. Many nurses also go on to receive additional education and licences, focusing on specific types of care. In the US, nurse practitioners (nurses with graduate degrees) can receive specific training in women’s health, family/general care and more.
#2: Midwives And Nurses Are Essential To Fill Gaps In Healthcare
It was once common for midwives to provide the majority of prenatal, birth, and postnatal care. In some countries, this is still the case. However, in many places (like the US) midwives serve only a small percentage of birthing women.
When it comes to well women and prenatal care, as well as general medicine, we simply don’t have enough physicians for everyone to receive quality care. Some project a physician shortage of 90,000 in the US by 2020. This recent research is important, as it shows we have quality healthcare providers available, not only to fill the gap, but also to provide equally good, and sometimes better, care.
#3: When It Comes To Birth, Midwives Are Often The Safest Option
Every pregnancy, every mother, every baby, and every birth is unique. Pregnancy and birth are natural bodily processes which often unfold well and without serious complications. Occasionally, however, things deviate from the norm and intervention is necessary. In these situations, it’s extremely important to have access to obstetricians.
However, research continues to show that for low-risk, and even some high-risk, pregnancies and births, midwives consistently have excellent outcomes. In countries such as New Zealand and Norway, most women utilise midwifery care for their pregnancies and, as a result, they also have some of the best maternal and neonatal outcomes.
This current WHO study found that there are no statistically important differences in major outcomes, but that in some areas nurses and midwives even outperform physicians. Births attended by midwives tend to involve fewer medications (epidural, IV pain relief, Pitocin/Syntocinon, etc), and women are less likely to have episiotomies.
An episiotomy is a surgical cut in the perineum. It was once thought to reduce the severity of tearing during birth, but has since proved to be more difficult to heal than a natural tear. Routine episiotomies are no longer recommended. They shouldn’t be done ‘just in case'. They should only be performed when medically necessary. Research shows, however, they’re still more common than they should be.
Obstetricians Receive More Training; Shouldn’t They Be The Safer Option?
It’s easy to assume that more time spent in school equals safer outcomes. However, it’s important to remember the impact training will have on care.
Physicians, specifically obstetricians, certainly learn about preventative care. However, they are also trained surgeons – trained to manage birth complications. In the absence of birth complications, some birth management practices can actually lead to poorer birth outcomes for lower risk women.
Midwives are trained to facilitate normal physiological labour. They’re also trained to recognise signs of complications. Only then do they manage birth, treat complications, or transfer care to a higher risk provider like an obstetrician.
Managed care might sound safer, but every intervention also carries risk. You cannot manage all labours, in the hope of catching the occasional deviation from normal birth, without adding in risks of interventions.
Every OB and midwifery practice varies but, in general, midwifery practices tend to be smaller and provide more personalised care, based on traditional midwifery care. Personalised care includes patient education, nutrition education, and getting to know an individual’s normal state of health.
Knowing a patient means risk factors for complications might be caught sooner. Preventative care can be implemented, which is preferable to treatment after a complication has already arisen.
Physicians, nurses, obstetricians and midwives all have vital roles in maternity and general health care.
This study, and others, are not suggesting nurses and midwives replace physicians. What it shows, however, is that nurses and midwives can provide quality care in many situations. The expertise of physicians can be reserved for cases where advanced medical treatment is necessary.