Midwifery is one of the oldest roles in the world, with versions of midwifery predating every medical field. Easing women through the pregnancy process and increasing the likelihood of survival for both the mother and the child – it has existed since the dawn of civilization, and it was by watching midwives that inspired Ignaz Semmelweis’ groundbreaking policy of hand washing in medical settings.
Midwifery did experience a decline in popularity in the United States. This decline was not seen in other nations – like the UK where all planned births are attended by midwives. In the UK midwives are there through the entire process and are available for every type of delivery from at-home births all the way to C-sections. In the United States, midwives are only present at around 8% of births.
It is telling, then, that it is statistically safer to deliver a baby in the UK than it is in the US.
This dates back to the 1940s in the UK, when maternity care was standardized, which has resulted in more comprehensive and consistent care from prenatal appointments all the way to post-birth care. Furthermore, in the UK mother fatalities are investigated, as opposed to the US where they are considered personal tragedies and rarely investigated, much less lead to national reform.
The biggest difference between the types of care is in the focus on the mother, a focus that requires midwife care. By providing equal emphasis on the care of the mother, and not solely on the fetus (as is common in the USA) issues like hemorrhaging and preeclampsia can be prevented.
The statistics are damming. Around 8.9 out of every 100,000 women will die during birthing complications in the UK. In the United States around 25.1 women per 100,000 will die, around 3x higher.
Reducing this death rate is achieved by recognizing preeclampsia early on. In fact, by emphasizing reducing risk and providing better care for the mother, the UK has substantially lowered the cost of delivering. In the United States it costs around $30,000 to $50,000 to deliver an infant, depending on whether it is via vaginal birth or cesarean section. In the UK that cost is around $2,300, with more complicated cases rising to $3,400.
This preventative care approach is typically handled by midwives. Women who are not expected to have a complicated pregnancy will see a midwife every four weeks, and in many cases will not see a doctor at all during her pregnancy. Even in instances where the birth is expected to be complicated women in the UK will be cared for by both a midwife and a obstetrician.
Considering the role that midwives have played not only in bringing forward new generations, but also in influencing lifesaving healthcare protocols, it is time that in the United States the myths of midwives are untangled, and that new technologies bring midwifery out of the limelight and back into common care practices.
The Increase of Midwifery in the United States
Greater access to online information has driven up interest in midwifery in the last few years, but there is still a lot of misconceptions around midwifery as a whole. For many midwifery is still considered a fringe medicine. It was used back before giving birth in a hospital was the norm, and is seen as the unsafe, unhygienic version of a hospital birth, which has been glamorized for decades.
Part of this misconception is that midwives are not formally trained, meaning that they can guide you through giving birth but have absolutely no understanding on how to spot complications or how to help if they happen.
This is simply not true. Like all other areas of healthcare, midwives are exceptionally well trained and have years of education under their belt. To become a midwife, for example, a nurse will need to hold not just a BSN, not just an MSN, but a DNP – the highest level of education a nurse can currently pursue. DNP midwifery programs include BSN to DNP tracks, and also post-graduate programs designed for MSN-holding APRNs.
To enter such programs there are also much higher requirements than other programs. As an RN you will need to have worked for at least one-year full time within a mother-baby unit, an outpatient OB/GYN, or with a doula.
Once completed, midwives will be doctorate-holding APRNs, with advance knowledge on mother and fetus care, as well as guiding the parent through the entire process from start to finish. Midwives work alongside hospitals in more complicated cases, and consistently help expecting parents get the answers, support, and guidance that they need to enjoy a more holistic and safe pregnancy and birth.
There are many reasons why midwifery is expanding in the United States, and though the meat of the issue is the greater quality of care and the increased body autonomy, technology plays a huge part.
How Technology has Improved Midwifery
Technology has thrust midwifery back into the spotlight for three key reasons.
Greater Access to Information
One of the greatest reasons why midwives have increased in popularity once again is due to the Internet. With more access to information expecting parents often take researching into their own hands, as it is the first and fastest way to get the answers they are looking for. Part of the information that is common to find are horror stories posted both by the news and personally by bloggers on the terrible care or experience that they had by doctors in hospitals.
The media has also influenced the popularity of midwifery. Shows like Call the Midwife have thrust both the role and its importance into the living rooms of Americans around the country. A greater emphasis on holistic care throughout all aspects of our lives, championed by influencers and spokespeople online, is another reason for the rise in popularity.
Online Education and Training
Midwives are highly trained and earn six figure salaries as APRNs. Online education, however, has meant that more RNs and APRNs can enroll and learn from the best programs in the country, all while continuing their work in hospitals, clinics, and elsewhere.
Telehealth
Getting to patients was another barrier that has been solved by greater advancement in technology. Telehealth has allowed nurses, doctors, and in this case midwives the ability to connect to, talk, and monitor their patients from afar, providing better quality of care even for those in the most rural of areas.
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