Friday, March 6, 2009

Where do they come up with this stuff?

After watching BoBB the other night, my friends and I were talking. One told us about a discussion she had had with an OB resident. She mentioned to him that she was looking into her options for her next child's birth and considering choosing a midwife (for a hospital birth). Apparently he tried to talk her out of it, saying midwives were much less safe. It almost made me wish I had been there... so I could have asked him, "Based on what? Show me your research." I don't know if I would have had the guts to actually say those words (being non-confrontational by nature). But I can't stop thinking about it. And it's got me on the defensive and all riled-up 'cause, clearly, I'm a huge fan of midwives. So I'll just refute him here . Since my friend is only considering midwives who can deliver at a hospital, I'm going to focus my proof on certified nurse-midwives (since they're the only kind of midwives who can deliver in hospitals).

1) Mortality Rates
There are many levels of "safety" when it comes to birth. When doctors use the word, I think they're generally referring to the most basic level of safety--a mother and baby who are alive. So what does the research say about CNM vs doctor mortality rates? Here are a few excerpts...
"After controlling for social and medical risk factors, the risk of experiencing an infant death was 19% lower for certified nurse midwife attended than for physician attended births, the risk of neonatal mortality was 33% lower" (MacDorman, M.F., Singh, G.K. (1998). Midwifery care, social and medical risk factors, and birth outcomes in the USA. J Epidemiology & Community Health, 52).
Regarding the above study: "Certified nurse midwives attended a greater proportion of women who are at higher risk for poor birth outcome: African Americans, American Indians, teenagers, unmarried women, and those with less than a high school education. Physicians attended a slightly higher proportion of births with medical complications. However, birth outcomes for certified nurse midwives were better even after sociodemographic and medical risk factors were controlled for statistical analyses" ("Infants Delivered by Certified Nurse Midwives have Lower Mortality Rates," National Center for Health Statistics Press Office, May 19, 1998).
"A nurse-midwifery program providing for the education of nurse midwives and integrating them into the existing health team helped reduce dramatically the infant mortality rate in a Mississippi delta county from 39.1 to 21.3/1000 live births in less than 3 years" (Meglen MC; Burst HV, Nurse-midwives make a difference. Nursing Outlook. 1974 June;22(6):386-389).
"[A] search of the scientific literature fails to uncover a single study demonstrating poorer outcomes with midwives than with physicians for low-risk women. An advantage to midwifery care is that evidence shows primary care by midwives to be as safe or safer than care by physicians" (Marsden Wagner, MD, MSPH, "Midwifery in the industrialized world").
2) Other Measures of Safety
Coming out of birth alive isn't the only thing that matters (a fact that many medical professionals seem to forget). How do certified nurse-midwives compare in other measures of safety? Let's take a look...
"Significant differences . . . between the obstetrician and nurse-midwife groups were found for seven clinically important outcomes: . . . infant remaining with mother for the entire hospital stay (15 versus 27%), third- or fourth-degree perineal laceration (23 versus 7%), number of complications (0.7 versus 0.4), satisfaction with care [higher with CNMs]" (Oakley D; Murray ME; Murtland T; Hayashi R; Andersen HF; Mayes F; Rooks J. (1996). Comparisons of outcomes of maternity care by obstetricians and certified nurse-midwives. Obstetrics & Gynecology, 88).
"The obstetric outcomes of a primary-care clinic for low-income women staffed by certified nurse-midwives is compared with the obstetric outcomes of a group of four obstetricians’ private practice patients. The birth outcomes were comparable with a significant reduction in cesarean sections (13.1% to 26.4%) for CNMs’ patients" (Source [Blanchette H. (1995). Comparison of obstetric outcome of a primary-care access clinic staffed by certified nurse-midwives and a private practice group of obstetricians in the same community. American Journal of Obstetrics & Gynecology, 172, 1864-1868]).
"The Medical University of South California Twin Clinic study demonstrated a lower rate of very early pre-term births, very low birthweight infants, Neonatal intensive care admissions, and perinatal mortality in a CNM directed Clinic where CNM care is given when compared to a MD directed team where MD care is given. This demonstrated that the contributions of CNMs to high-risk prenatal care can be considerable" (Source [Ellings & Janna, et al. (1993). Certified-nurse midwife directed twin clinic reduces very low birthweight delivery & perinatal mortality. Journal of Obstetrics and Gynecology ]).
"The risk of delivering a low birthweight infant was 31% lower. Mean birthweight was 37 grams heavier for CNM attended than for physician attended births. The authors, from the Centers for Disease Control and Prevention, National Center for Health Statistics, conclude that national data support findings of previous local studies that certified nurse midwives have excellent birth outcomes, and CNMs provide a safe and viable alternative to maternity care in the United States, particularly for low to moderate risk women" (MacDorman, M.F., Singh, G.K. (1998). Midwifery care, social and medical risk factors, and birth outcomes in the USA. J Epidemiology & Community Health, 52).
I could keep cutting and pasting, but this post is getting rather long. Is there really anything unclear about the research?

So... where do they come up with this completely false notion that midwives are less safe?! When will medical schools, the media, and popular opinion reflect the actual truth about midwives?? When, oh when??


Cindy and Steve said...

LOVE IT!! I love all the research you do! It is much appreciated!!

The Winn's said...

Thanks Lani!

Azúcar said...

One of the key stats that helped me convince my husband that CNMs were where it's at was the clinic's c-section rate. My state's OB c-section rate is approaching 30%. My CNM's rate is 8%. EIGHT PERCENT. Talk about which one is more unsafe for women and babies.

Buscando la Luz said...

Midwives' cesarean rates make me happy. Thanks, Azucar. :-)

Cassie said...

"Coming out of birth alive isn't the only thing that matters"


I think the whole "midwives are unsafe" attitude comes from the beliefs of the whole smear campaign. Also, if midwives get business it means that doctors don't.

Faithful Lurker said...

My doctor actually told me he is supportive of my decision to use a midwife if I choose. He said he can't believe how many people are freaked out by homebirth and midwives when really it is safe and mostly misunderstood. I about fell off my chair!

Buscando la Luz said...

I think I would have fallen off my chair too. Wow!

Sarah H said...

Awesome compilation. I love midwives too. I have only dealt with CNMs but I'm hoping to meet some direct entry midwives in the future. (CPMs don't have licensure in Illinois-- a bill was attempted but it just failed. Sad.)

日月神教-向左使 said...