There’s a trend happening in Michigan (also a part of a national trend) that is making the birthworker community nervous and concerned about the quality of care that is provided to birthing families.
Starting to see the wave of even less midwifery care options for birthing families
Ascension hospital chain has decided to be more “cost-effective” by cutting midwives staff from the Labor & Delivery floor at their hospitals with little advance notice. They promised that their OBGYN is experienced in “low-intervention births.”
- Ascension Providence in Southfield, MI
- Ascension Borgess in Kalamazoo, MI
- In Spring 2022, the physicians made the decision to cut the number of midwives in their practice from seven midwives to three. The way the oncall schedule work, it would make it harder to find a midwife available on the L&D floor for every birthing person who wants a midwife to attend their birth. An experienced doula say that there’s actually only one midwife on staff there.
- Read blog by my mentor, doula trainer and childbirth educator, Jessica English
- Ascension Borgess Allegan Hospital in Allegan, MI is eliminating midwives from their L&D floor starting March 1, 2023
The issue is usually the midwifery model of care is different from the medical model of care. Midwifery care means that pregnancy and birth are viewed as life events - and it’s more family centered care. Whereas obstetrician-led models of care, see pregnancy as a disease, something to be managed or looking for something that could or will go wrong.
Wait, we don't want OBGYNs?
Nope, that’s not what I’m saying at all. Is there a time and place for skilled OBGYNs? Absolutely! If pregnant people are high-risk or have some kind of complicated medical issues that need to be under the care of highly trained professionals that can improve the outcomes of both the babies and birther, it can be life saving.
However, most birthers are low-risk and do not require all medical interventions that could negatively impact the outcomes in birthers and babies.
Why would hospitals want only highly trained OBGYNs to manage low-risk birthing persons who desire little to no medically unnecessary interventions? It’s just a poor way of using highly trained professionals to attend births that doesn’t require those skills.
It would be like asking Michelangelo to paint my bedroom a solid green color. Why would I hire him to do that? Wouldn’t his skills be better served for those who want a mural or painting worthy of his caliber and skills?
It would be like asking a transmission specialist mechanic to wipe down the mirrors on my car. But why? It would make more sense to use their time and skills more for problems that they are more trained to solve like fixing the transmission.
Why is this happening?
The hospitals claimed that it's "not cost effective" but that doesn't make sense. Midwives save the patient and the insurance money. Reduced cost for unnecessary interventions. So the question I'd like to ask is "cost-effective for who?" Certainly not you.
We need OBGYNs in hospitals. So the next thought is to cut midwives.
Midwives aren’t trained to do surgery like OBGYNs are. They are more skilled in more physociological and low-risk vaginal births. There’s an alarming trend of hospitals closing their Labor and Delivery wards because it’s expensive and not as profitable.
That is an equity issue for those in rural areas (where some will have to travel up to an hour to a hospital to give birth) and for those in urban areas. This negative impact a lot of areas where Black and Brown people live and give birth.
Ascension has made an announcement that they will end maternity care at Ascension Macomb-Oakland in Warren and at Ascension River District in East China Township this year. Ascension Macomb-Oakland will consolidate care with the larger hospitals.
They are saying it has to do with declining birth rates that it’s not cost effective to continue.
Research has shown that the midwifery model of care has better outcomes such as a decrease in preterm births, a decreased risk of needing cesarean, decreased infant mortality and it’s all at a lower cost to families and insurance companies.
Imagining a different model of care
I was talking to a friend who gave birth to her first child in England. She told me that they automatically provided you with a midwife unless you were high-risk then they would pair you up with an OBGYN. If you were low-risk, they would ask if you wanted to give birth at home or at the hospital. Once the baby is close to being born, they call in a second midwife to look after the baby while the main midwife looks after the birthing person. They also provided nitrous oxide that you can take home to use in labor.
What. That blew me away. It’s a completely different system, here in the United States.
Around the world, midwives are the default provider unless there was a serious complication or if the birther was high-risk.
Here’s an excerpt from Evidence Based Birth…
“In many countries around the world, midwives actually make up the vast majority of the obstetric care workforce. For example, in the United Kingdom, there are more than 31,000 midwives compared to 6,000 obstetricians.
In Germany, there are around 24,000 midwives compared to around 4,000 Obstetricians and in Japan there are more than 25,000 midwives compared to less than 8,000 OBs. This is in contrast the situation in North America. In the United States, there are about 12,000 certified nurse midwives, and 102 certified midwives and about 2,400 certified professional midwives. This is in comparison to 43,000 obstetricians in the United States. In Canada, there are roughly 1,900 midwives compared to more than 2,000 obstetricians.
In the United States, there are typically around 4 million births each year, and the majority of these births are attended by physicians, with only about 9% attended by certified nurse midwives, or certified midwives, and less than 1% attended by certified professional midwives or traditional midwives. Now, if you only look at vaginal births, midwives do attend a higher proportion of vaginal births in United States, but still only about 14%.”
Ideally, midwives would be the standard of care. Then all the hisk-risk and medically complicated cases can go with a specialist- an OBGYNs. If midwives and OBGYNs can work together in a truly collaborative environment, that would be a win-win.
This actually lightens the load of the OBGYNs to dedicate more time and care for those birthers with complicated medical issues that require their expertise. That would mean more personalized care for each birther in both the care of midwives and OBGYNs.
What studies have shown about the Midwifery model of care?
The 2016 Cochrane review (aka basically looking at all studies at one topic and then make a conclusion based on that) revealed that midwifery care led to:
- Women were less likely to experience needing an epidural or spinal tap, needing an instrumental birth (aka forceps, episomitey and/or vacuum), and preterm birth.
- Lower rates of fetal or neonatal death.
- Risk of having a preterm birth with a midwife was reduced by 24%.
- Women had an increase in spontaneous vaginal birth compared to all other models of care.
- Decrease chance of having water artificially broken
- Decrease in use of episiotomy
- Less likely to have any pain medication, their labor were longer and more likely to have someone at the birth that they knew
In this New York Times article, it found that the cesarean rate, preterm rates were significantly lower in Sweden then in the United States, for both the wealthy and the poor. What was the difference? The mode of care. Midwives do the majority of the care for birthers in Sweden.
We can't talk about the outcome of births without talking about the maternal mortality crisis among Black mothers in the United States.
A latest study out of California (which has the one of the best support for birthing families in the United States - providing paid family leave for all residents), has revealed that even in that setting the richest and the poorest Black Mothers and babies had more premature babies and deaths than the richest AND the poorest white mothers and babies.
It's important to note that it's not that race is the risk factor. It's racism that is a huge risk factor.
What is one of the ways we can address the maternal and infant health crisis among Black and Brown families? Having more midwives.
What can be done?
Fill out the patient satisfaction surveys
If you recently gave birth at a hospital with midwives and loved it, please mention that you loved having a midwife at the birth and it was a reason why you picked that particular hospital or provider practice. Patient satisfaction is really important to hospitals, so if they hear from people in the area that they want midwifery care, it'll make a stronger case for them to stay.
Sign the Petition
Below is the link to the petition you can sign about raising your concern about the elimination of midwives at at Ascension Providence in Southfield, Michigan.
Education about the role of Midwives
I think education would help also! I used to think it was that doctors were more qualified to attend births and I think that’s why some low-risk or low-stakes pregnant people go with doctors instead of midwives. I think that’s a misunderstanding. Midwives are qualified to attend births that are normal, healthy and low-risk or low-stakes. Doctors are very qualified to attend births that are high-stakes or high risk.
There’s a misconception and misunderstanding of what midwives do. Midwives are trained to attend vaginal births and some actually do support epidural births if they are hospital midwives.
There’s different training paths for midwives - Certified Nurse Midwives, Certified Professional Midwives and Traditional midwives. They all have different levels of training - some require a nursing degree and a masters, others require several years of training and apprenticeship, and so on.
Usually hospitals will employ Certified Nurse Midwives. Homebirth midwives can be one of the three types. Usually all are trained to support babies born in different fetal positions, if the baby needs a little help breathing - they know what to do to assist, and usually see the birther and baby more holistically. They will know when they should transfer care to an OBGYN if they see a risk factor that indicates that it is needed.