Declining Rates Of Midwife-Attended Childbirth Related To Increase In Medical Procedures Used During Labor, San Francisco Chronicle Reports

Main Category: Pregnancy / Obstetrics
Also Included In: Nursing / Midwifery
Article Date: 04 Jun 2007 - 18:00 PDT

email to a friend   printer friendly   opinions  

Some health professionals believe that the declining rate of midwife-attended childbirths is related to an increase in medical procedures -- including caesarean section, epidurals and labor induction -- used during labor, the San Francisco Chronicle reports.

According to CDC's National Center for Health Statistics, midwife-attended births increased from 1% to 8.1% from the mid-1970s to 2002. In 2004, the most recent year data is available, 325,000 births, or 7.9% of all births in the U.S., were attended by a midwife, according to NCHS. Some physicians and midwives say they believe the declining rate of midwife-attended births is associated with an increase in medical procedures used during labor, the Chronicle reports.

According to the Chronicle, about 30% of all births in 2004 ended in c-sections, an increase of 21% since 1997. In addition, the use of other forms of medical intervention, including epidurals and labor induction, are increasing, the Chronicle reports. The practice of vaginal birth after caesarean also has decreased from 28.3% to 9.2% of women who have had a c-section.

Elena Gates -- vice chair of the Department of Obstetrics, Gynecology and Reproductive Sciences at the University of California-San Francisco -- said that physicians by training are going to evaluate a situation from a medical perspective. "The fundamental approach to pregnancy as ... sort of a natural part of life, as opposed to something that's medicalized, is the key cultural difference between midwives and obstetricians," Gates said, adding, "Some women may say, 'I'm willing to risk a little in terms of safety to have the birth I want.' But an organization of professional physicians isn't necessarily going to see it the same way." The push for medical intervention also comes from women who are "perfectly happy to make medical decisions and have it taken care of," Gates said.

Naomi Newhouse -- chair of midwifery at Kaiser Northern California and president-elect of the California Nurse Midwives Association -- said that there are issues at some hospitals "about competition, and physicians wanting the patient population. But I think that's going to change over time because the insurance companies are figuring out [midwifery is] a really good idea." She added that when "cost-effective care is paramount, midwives are a lot less expensive."

San Francisco-Area Midwifery Practice Closes
In related news, the San Francisco-based St. Luke's Hospital's Homestyle Midwifery will close on Aug. 1, the Chronicle reports. According to the Chronicle, the hospital has given the midwife who runs the program the option of staying on in a private practice.

Hospital officials said they support Homestyle and hope the program is able to continue at the hospital. William Miller, chief medical executive at St. Luke's, said the hospital emphasizes care for low-income patients and cannot afford to keep what is essentially a "boutique" program that provides one-on-one midwifery care. He added that with the potential loss of Homestyle, the number of midwifery-attended births at the hospital will not change.

Elizabeth Steinfield, a nurse-midwife at St. Luke's, said, "Support for midwives has always been a problem, and it varies from setting to setting and fiscal year to fiscal year." She added, "Midwives can be very cost-effective if used properly, but if not, people can't figure out why [midwives are] around" (Allday, San Francisco Chronicle, 5/29).

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

• Additional
• References
• Citations