Midwifery, which has deep roots in Black, Indigenous and immigrant cultures, was discredited and nearly phased out in the U.S. in the early 1900s as mostly white male doctors campaigned against the profession.
“The midwife is a relic of barbarism,” Dr. Joseph DeLee, the Chicago-based “father of modern obstetrics,” wrote in 1915. “In civilized countries the midwife is wrong, has always been wrong.”
DeLee was wrong then, and he would be dead wrong now: Research shows that midwife-attended births are as safe as deliveries handled by doctors, and they are associated with lower rates of cesarean sections, which can be life-saving but in some instances, unnecessary.
While more Americans with low-risk pregnancies are seeking the assistance of midwives, these certified health professionals still aren’t valued as much in the U.S. as they are in other developed countries where the maternal mortality rate is much lower.
Chicago-area hospitals seem to be dismissive of midwives too, since their hiring isn’t much of a priority and positions are being cut, WBEZ’s Kristen Schorsch recently reported.
There’s also a scarcity of midwives of color and fewer midwives working at South Side hospitals, another example of the health care inequities that affect Black women, who are three times more likely than white women to die from pregnancy-related complications.
A ‘high-touch, low-tech’ approach to pregnancy
Midwives, nurses with an advanced degree, only attended to about 9% of births in our state in 2020.
The low numbers shouldn’t come as a surprise when there may be only one hospital in Chicago, UI Health, that has an adequate roster of 18 midwives who deliver babies and provide routine gynecological care using a “high-touch, low-technology” approach many expectant mothers crave.
Other facilities, meanwhile, are limiting this type of care.
University of Chicago Medical Center has only one midwife. There were more in previous years.
And at Swedish Hospital, where the midwifery group combined with the OB-GYN physicians’ group over the summer, there are only two midwives left — eight fewer than in 2015, according to Schorsch.
“Illinois clearly has not really embraced midwives,” Karen Jefferson, director of midwifery practice and education at the American College of Nurse-Midwives, told Schorsch.
The good news is that the state is currently ironing out the rules for a law Gov. J.B. Pritzker signed two years ago allowing midwives without a nursing degree to go through a newly created licensing process and be legally recognized by Illinois to provide care before, during and after delivery.
But if hospitals aren’t paying their midwives well, or just aren’t hiring or are eliminating these jobs, the motivation to undergo training for a profession that is beneficial to both mothers and their newborns could wane.
“The struggle of midwives for recognition as skilled, autonomous professionals is not only a barrier to career progression, but also a disincentive for people to consider a career as a midwife,” a 2020 study published in The Lancet Global Health noted.
That study estimated that millions of maternal deaths, neonatal deaths, and stillbirths in 88 low-income and middle-income countries could be averted by 2035 if more midwife-delivered care is available.
There is no question more midwives would also benefit expectant mothers in our country.
Some midwife advocates believe that there are financial factors motivating the reluctance to keep midwives on staff. C-sections, which continue to spike in the U.S. despite a call to reduce the use of the procedures when they aren’t needed, bring in more money to doctors and hospitals than vaginal births. But C-sections also increase the chances of potential complications, including infections and blood clots.
Births involving midwives may take longer. That may place an additional burden on hospitals, many of which are dealing with staff shortages and are scrambling to find OB-GYNs. But if patient safety is the backbone of the Hippocratic oath, there ought to be a shift in how midwives are viewed and represented in the hierarchy of medicine.
A concerted effort to integrate midwives into the health care system here in Illinois and elsewhere in the U.S. would strengthen maternal care.
DeLee and his cohorts would disagree. But they are long gone. Valuing midwives is something modern medicine should embrace.
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