Can Midwives Help Reduce The Number Of C-Sections?

Aug 21, 2014
Originally published on August 21, 2014 12:37 pm

There was a time when midwives delivered most babies. But in recent decades in the U.S., that practice has become the domain of obstetricians.

Now, we’re coming full circle--these days women are choosing midwives for maternal care. Some hospitals are even adding midwifery as a way to expand their service, and to help reduce unnecessary C-sections.

Increasingly, Washington hospitals are adding midwives to their roster. Whidbey General Hospital in Coupeville, Washington, is one of the more recent ones.

The state is trying to reduce the number of low-risk C-sections that are not medically necessary. Whidbey General had one of the highest rates of low-risk C-sections last year.

The reasons listed are many, according to Nurse manager Trish Nilsen: higher rate of obesity, vacationing pregnant women and moms from the Navy base nearby.

'A Rite Of Passage'

But that number is going down. In 2012, nearly half of first time, low-risk moms had C-sections. So far this year it’s one-third. The hospital made some changes, and that included hiring a midwife.

Sarah Meyer, a certified nurse midwife, joined the hospital last February. She delivers babies and can order epidurals or pain meds like obstetricians. But her approach is more focused on using natural remedies, fewer drugs.

“All interventions we have are important, and there are certainly times when we need to use it, and use all of it, but not at every birth,” she said. “Women have lost the kind of rite of passage that birth can be and we need to remember that this is a life-changing event that can be very powerful for women.”

Meyer started practicing in her native New Zealand where it’s common for midwives to work alongside obstetricians. But there are clear boundaries. Midwives care for women like Christine – normal pregnancy, no complications.

“Obstetricians are the specialists who would look after women considered high risk,” Meyer explained, “so they would have medical conditions that would affect them in pregnancy, or if they had problems in labor, then the midwives would consult the obstetricians and they would be called.”

In the U.S., midwives and obstetricians don’t often practice together. But the walls are slowly coming down. At Whidbey General, Meyer works with two obstetricians. Patients can choose Meyer to deliver, but if complications come up during pregnancy or a delivery requires specialized care, one of the obstetricians steps in.

A Different Option For Those Who Want It

Dr. Robert Burnett has worked with midwives throughout his 35-year career, so it wasn’t a big adjustment. He said having a midwife provides a different option for those who want it.

“They do a lot more hand holding the whole time during labor where we tend to have labor and delivery nurses manage those sort of things,” he said. “We’re sort of the overseer to make sure things are going well and no complications are happening.”

Burnett doesn’t believe having a midwife alone has made an impact on lowering the hospital’s C-section rates. He said the state has new guidelines, like allowing women more time for their labor to progress.

Many of those steps are consistent with midwifery practices, and the combination has made a difference. And it has helped providers like him when they counsel women who are anxious to speed up their delivery.

“They’re tired, they’re uncomfortable, they’re swollen, they don’t feel good and they want to be done, 'my due date was yesterday' — it’s hard to put them off,” Burnett said.

“Now it’s actually easier," he added. "We say we have these policies. 'I know you’re uncomfortable but everything’s normal with your pregnancy, and it’s safer for us to give you more time to go into labor.'”

Burnett expects to see more of this type of integration as health care costs continue to rise. The big drawback, he said, is that a midwife can’t take calls for him; it has to be another obstetrician.

'We Support Each Other'

Nilsen said she believes the obstetricians learned from Meyer while credentialing her for deliveries. “As they proctored her, they observed her techniques and started picking them up,” she said.

Those techniques help to reinforce the new statewide guidelines.

When Meyer arrived at Whidbey General, there were some initial adjustments in the office and in the delivery room. Now they’re at a point where their practice more resembles her experience in New Zealand.

“What I love about this practice is that the obstetricians and I really work collaboratively and so we support each other,” Meyer said. “And I think that’s actually the best way midwives and obstetricians work, it’s if we are together as one team.”

The hospital staff may be on board, but some patients are still learning about midwifery. Meyer said it’s going to take a little time and word of mouth before expecting mothers know the service is available in their community.

For her first baby, 25-year-old Christine Meyer -- no relation to Sarah -- chose Whidbey General because the hospital offered midwifes.

“I love it,” Christine said. “I love Sarah. I’ve heard great things about her from the nurses at the hospital. They just think she’s fantastic. So I’m excited to have her there while I’m giving birth.”

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