The BBC series Call the Midwife has been a surprising smash hit with American PBS audiences. The series features midwives Jenny Lee, Chummy Browne, Trixie Franklin, and Cynthia Miller as they live and work with nuns at Nonnatus House in London’s East End during the 1950s. The nurses experience heartache and pain as they help women through the difficult and often dangerous process of childbirth while their patients live in abject poverty.
Midwives Across the World
Every year in the UK more than half of babies are delivered with the guidance of a midwife. In Scandinavian countries it’s more like three-quarters, similar to the rate in France. In fact, in these and many other countries, midwives take part in almost all deliveries, as they also assist OB-GYNs in more complicated cases.
Midwives in America Today
According to the American Midwifery Certification Board, as of August 2017, there were 11,826 Certified Nurse Midwives working in the United States. In 2014 ( the most recent year for which final birth data are available), CNMs attended 332,107 births, 8.3% of total US births. 94.2% of CNM attended births occurred in hospitals, 3% occurred in freestanding birth centers, and 2.7% occurred in homes.
When you consider that there are 2.75 million registered nurses currently working in the US, 11,000 Certified Nurse Midwives are relatively few. In the US less than 10% of deliveries are led by midwives. The rate has languished in the single digits since a century ago when expectant mothers largely stopped using midwives to embrace doctor-led childbirth, believing that was safer.
A New Trend
Ironically, that shift has resulted in myriad problems stemming from the overuse of medical protocols in childbirth. Those problems are reflected in the country’s high rate of C-sections as well as in the deluge of medications that comes with medically managing labor; a problem that even the American College of Obstetricians and Gynecologists (ACOG) acknowledges.
The high rates of surgery and other unneeded interventions have led to increased interest in the midwifery model, which is lower-tech, less invasive, and less inclined toward intervention without a clear medical need.
A 2016 study by independent research organization Cochrane found that for low-risk pregnant women, or for those who were at risk of complications but who weren’t experiencing them yet, delivering their babies with a midwife rather than a doctor was associated with a smaller chance of premature birth or spontaneous abortion. They were also more likely to have a spontaneous vaginal delivery and less likely to need a C-section, an epidural, or require the use of instruments such as forceps. European countries that lean more heavily on midwives also have better outcomes for babies and their mothers. Maternal mortality rates there are a fraction of America’s.
The Midwives Model of Care
Certified Nurse Midwives do so much more than attend deliveries. Their modern model of care includes:
- Monitoring the physical, psychological, and social well-being of the mother throughout the childbearing cycle.
- Providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support.
- Minimizing technological interventions.
- Identifying and referring women who require obstetrical attention.
- Because of the additional licensure in nursing, a nurse-midwife can offer the most comprehensive array of health care services to women.
- These services include annual gynecological exams, family planning and preconception care, prenatal care, labor and delivery support, newborn care, and menopausal management.
The trend among American expectant mothers is to want minimally invasive prenatal care and a completely natural childbirth experience. More and more, they are tending to
Call the Midwife