Midwife Connection

By Holly Powell Kennedy, CNM, PhD, FAAN, FACNM, President, American College of Nurse-Midwives

Today ACNM’s peer-reviewed journal, the Journal of Midwifery & Women’s Health (JMWH) released the long awaited and much anticipated National Birth Center Study II (NBCS II). The first study of this magnitude since 1989, NBCS II features the outcomes of 15,574 births to women who sought care at midwife-led birth centers. As midwives, we know our unique, woman-centered style of care leads to excellent results for both moms and babies. NBCS II provides a fresh, hefty dose of evidence to put that care on display for the American public, professional colleagues, and policymakers that can lead to a change in the way maternity care is delivered in the United States.

The results of the study are overwhelmingly positive for midwifery, most notably due to an impressively low cesarean birth rate coupled with high safety standards. Less than 6% of NBCS II study participants had a cesarean birth compared to a national US cesarean rate of 32.8% in 2010. Even when we look at women receiving care in a hospital setting with low risk pregnancies similar to the study participants, the current cesarean rate is estimated to be almost 24%[1].

The births were safe, too: only 1.9% of transfers to hospitals were due to emergencies, the rate of fetal and newborn mortality was comparable to those in low-risk hospital care, and there were no maternal deaths. NBCS II shows that even women who leave birth centers and are transferred to hospitals to have their babies after labor begins have excellent birth outcomes and significantly lower cesarean rates. What makes birth center care so much comprehensively better? I have no doubt that a contributing factor is the prevalence of midwifery-led care.

It’s no secret that the state of US maternity care is of concern to providers across specialties, and that midwives, physicians, and nurses alike have been pushing to lower the rate of cesarean birth, but NBCS II is also notable because of what it could mean for the cost of giving birth in America. Spending on maternity care could decline by more than $5 billion if the cesarean rate was reduced to the recommended 15% of births[2]. If even 10% of the approximately 4 million US births each year occurred in birth centers, the potential savings in facility service fees alone could reach $1 billion per year. Increasing access to midwifery and birth center services would drive down costs in our over-burdened health care system, while also ensuring safe, quality care in pregnancy and childbirth.

Last year, we launched Our Moment of Truth™: A New Understanding of Midwifery Care, a targeted public awareness initiative designed to start changing the way Americans think about midwives when they make decisions about their health. It’s now time to go live with the impressive results of this birth center study, and we invite you to participate! Let your friends and colleagues know about NBCS II by sharing some of our Tweets and Facebook posts, and direct them to ourmomentoftruth.com when they want to learn more about the excellent outcomes of midwifery care demonstrated in the study. Please help us spread the word about NBCS II, and help moms and babies get healthier with fewer dollars spent. Let’s keep the tide turning for midwifery care in the United States.