Study Supports Use Of Nurse-Midwives Fewer Costly Caesareans Reported When Midwives Attend
Women who give birth with the help of nurse-midwives are only half as likely to have a Caesarean section as American women overall, according to a national survey released Monday.
The findings suggest that wider use of certified nurse-midwives can help curb health costs without sacrificing quality of care, according to Public Citizen’s Health Research Group, which did the survey.
In addition, midwifery, with its emphasis on prenatal care, could “improve our still-embarrassing infant mortality record,” Dr. Sidney M. Wolfe said at a news conference Monday. Wolfe directs the research group, a Washington-based consumer advocacy organization founded by Ralph Nader.
The survey of about 650 nurse-midwifery practices and freestanding birth centers around the country found that from 1991 through 1993, only 11.6 percent of hospital births attended by nurse-midwives resulted in a C-section delivery. That compares with an overall U.S. C-section rate of 23.3 percent in those three years.
Most of the nurse-midwives who attend hospital births - 87 percent - said they care for some moderate and high-risk women, although their patients were predominantly low-risk. The study concluded that the nurse-midwives’ low C-section rate “is not mainly due to the risk profile of the population they serve.”
Caesarean sections are more expensive and riskier than vaginal births, and the medical profession has been working to reduce the high rate.
In addition, the survey found, nearly 70 percent of women who had a previous C-section were able to deliver vaginally in a nurse-midwife’s care, compared with a national vaginal-birth-after-Caesarean, or VBAC, rate of only about 25 percent.
Dr. Philip R. Lee, assistant Secretary of Health, used the release of the survey as an opportunity to argue for preserving women’s freedom to choose a nurse-midwife or freestanding birth center as high-quality, lower-cost alternatives to hospitals. He spoke at the news conference releasing the survey.
While this and other studies have supported the effectiveness of nurse-midwifery, and there is a greater acceptance of the profession now, there are still barriers to expanding its use, according to the survey and nurse-midwives.