We can thank the Editors at Scientific American for illustrating the famous H.L Mencken quote:
…[T]here is always a well-known solution to every human problem — neat, plausible, and wrong.
The U.S. Needs More Midwives for Better Maternity Care is a truly execrable piece lacking common sense, scientific support and historical accuracy. It’s neat, plausible and dead wrong.
[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]If mortality and C-section rates ROSE as the proportion of midwife attended births rose, how will increasing the number midwives make them fall? [/pullquote]
The ignorance is on display with the very first sentence:
Despite the astronomical sums that the U.S. spends on maternity care, mortality rates for women and infants are significantly higher in America than in other wealthy countries.
The fact is regardless of what ANY country pays on maternity care, mortality rates for black women and infant are significantly higher than other ethnic groups. The difference in mortality rates of industrialized countries largely reflects the proportion of black women in the population. “Whiter” countries have lower mortality rates.
For example, the US maternal mortality rate is 3-4X higher for black women than white women. In the UK, the difference is actually larger; black maternal mortality rate is 4-5X higher that of white women. So why does the UK have a lower maternal mortality rate than the US? Because black women represent 12% of the US population and less than 4% of the UK population.
…[T]he rate of cesarean sections is exceedingly high at 32 percent—the World Health Organization considers the ideal rate to be around 10 percent—and 13 percent of women report feeling pressured by their providers to have the procedure.
The World Health Organization FABRICATED their “ideal” C-section rate and as they themeselves have publicly acknowledged, there is no evidence and there has never been any evidence to support it. The best existing research on the topic shows that a MINIMUM C-section rate of 19% is necessary for low maternal and neonatal mortality and that rates above 40% are also compatible with excellent outcomes.
Having utterly mischaracterized the problem, the Editors offer their “solution:
Widespread adoption of midwife-directed care could alleviate all these problems. In many other developed countries, such as the U.K., France and Australia, midwifery is at least as common as care by obstetricians.
There is precisely ZERO evidence to support that claim. What are the C-section rates in these countries? It’s 33% in Australia, 26.2% in the UK and 20.8%. That’s hardly a ringing endorsement for the role of midwives in lowering the C-section rate.
What about maternal mortality? Women in the US die for LACK of access to high tech maternity care, the very care that midwives don’t provide.
A recent paper in New England Journal of Medicine What We Can Do about Maternal Mortality — And How to Do It Quickly offers four separate recommendations for reducing maternal mortality and all of them involve MORE high tech care, not less.
And if that weren’t enough to convince you that the Editors at Scientific American have no idea what they are talking about, consider this: the US C-section rate and maternal mortality rates have risen steadily as the proportion of midwife attended deliveries increased. How will increasing the number of midwives further lower these rates in the future when they couldn’t do so in the past?
In the U.S., certified midwives and nurse-midwives must hold a graduate degree from an institution accredited by the American College of Nurse-Midwives, and certified professional midwives must undergo at least two years of intensive training. This is designed to make midwives experts in normal physiological pregnancy and birth.
But whereas certified nurse midwives get similar education and training to European, Australian and Canadian midwives and meet the ICM [International Confederation of Midwives] international standards, “certified professional midwives” do not. Indeed, CPMs aren’t really midwives; they are lay people who are not allowed to practice in any other country in the industrialized world.
Most practicing CPMs have no education beyond a correspondence course and an apprenticeship with another substandard CPM. To understand just how poorly educated and trained these women are: the requirements for the CPM were “strengthened” in 2012 to mandate a high school degree. Almost all CPMs work outside hospitals at home or in unaccredited birth centers. Their neonatal mortality rates are 3-9X higher than those of nurse midwives. The Editors at Scientific American appear to have no understanding of this.
Nor do they understand that a midwifery who is an “expert in normal birth” is about as useful as meteorologist who is an expert in sunny whether. When birth is uncomplicated, you don’t need an any attendant, let alone an expert. You only need an expert when complications occur, the very situation for which CPMs lack education and training.
There’s much more wrong with the piece, including its revisionist history of the decline of midwifery care, but it’s enough to know that its central claims are flat out false. There is NO EVIDENCE that midwifery care decreases the C-section rate and NO EVIDENCE that midwives decrease the maternal mortality rate. Moreover, for the past decade the UK, where midwives are gatekeepers of maternity care has been rocked by a growing series of scandals involving the preventable deaths of dozens, perhaps hundreds of babies and mothers. Why did these babies and mothers die and why did hundreds more sustain severe injuries? In nearly every case it was because midwives refused to call for the doctors who could have saved them for fear of losing control over the patients.
Highly educated, highly trained nurse midwives are an asset in any US maternity care setting. I’ve worked with many and have high praise for the care they can provide BUT there’s precisely ZERO evidence that increasing the proportion of midwife attended births has any impact on either C-section rates or mortality rates. The Editors of Scientific American should be embarrassed that they ignored the scientific evidence — indeed appear to be utterly unaware of its existence — and printed midwifery marketing propaganda instead.
