Cecilia had always planned to deliver her baby with the help of a midwife, as she believed it would provide a more personal experience.
In the six months she worked with a midwife, Cecilia — who’s navigating her first pregnancy — said the process made her more confident in the care she received while offering her flexibility in what her birthing experience could look like.
Then, about eight weeks before her due date, Cecilia learned Swedish Hospital was changing its midwife program. Midwives would no longer work independently but as part of a team with the hospital’s doctors.
“It took me a second to process because I’m so close to my due date, and also part of midwifery is building these trusting relationships with the people you’re working with,” said Cecilia, who asked that her full name not be used for privacy reasons.
Swedish has allowed women to choose between a midwife or a doctor for over 20 years.
Earlier this month, the hospital announced its group of doctors and midwives will be working collaboratively at the hospital beginning Sept. 1, meaning a patient’s pregnancy care will be supervised by a team of doctors and midwives as opposed to one or the other.
With her baby due next month, Cecilia was shocked by the change and scrambled to transfer care to a new hospital that still had the option to use only a midwife.
Bridget Davidson, who worked as a certified nurse-midwife at the hospital for 11 years, said the hospital’s framing of a collaborative model is “deceiving at best.”
“The program that existed is over, and it’s important for people to know that,” Davidson said. “To discard a program that has such history and has made such a difference for so many people is shortsighted.”
At the program’s peak about five years ago, there were 10 midwives, and mothers were guaranteed midwifery care 24/7, Davidson said. Now, only two remain, she said.
The hospital declined to discuss staffing numbers, stating “information related to employees is confidential.”
Davidson, who resigned when she heard of the changes, said the new model leaves mothers who were set on having their births attended by a midwife having to decide whether they want to transfer to a new hospital or be open to a different model of care at Swedish.
Swedish Hospital said the move came because the number of births in the Chicago metro area has declined significantly in the last decade. The hospital also cited “staffing challenges” and “increased costs” related to the pandemic.
More midwife-attended births are happening outside hospitals, at independent birthing facilities, the hospital said. Swedish saw midwife-attended births decline 47% from 2016 to 2022.
“While we are confident this change will help provide our patients with expert support and resources, we know there are those who prefer a midwife-only model,” Swedish said in a statement. “In those cases, we will work closely with our patients to connect them with providers in our community that meet their needs.”
People may opt for a midwife because midwives can spend more time building trusting relationships with patients while offering emotional support before, during and after birth, said Karen Jefferson, a midwife and director of midwifery practice and education at the American College of Nurse-Midwives.
“Midwifery care is relationship-based and focuses on the whole person and putting the person at the center of the care,” Jefferson said.
There are many different approaches to midwife care at U.S. hospitals. Some hospitals have independent midwife groups, allowing patients to decide which care model they’d prefer; at others, midwives and doctors closely work together.
“It varies whether midwives have a lot of autonomy in hospital settings, but in all these circumstances, midwives bring their midwifery culture with them,” Jefferson said.
According to data from the American College of Nurse-Midwives, there were 455 midwives in Illinois in 2020, and they oversaw about 8.7% of live births in the state. Most work in the Chicago area. In 2021, Illinois became the sixth state in the Midwest to license midwives and allow them to provide pregnancy services without being certified nurses.
Compared to other Chicago hospitals, Swedish Hospital’s midwife-attended births had a low overall C-section rate (12.3%) and a high rate of women carrying out vaginal births after previously having C-sections (28.9%), according to data from Birth Guide Chicago.
C-sections are a major surgical procedure that can come with greater health risks and are more invasive than vaginal births, Jefferson said, so low C-section rates and high rates of vaginal births speak to the impact and effectiveness of midwives.
Cecilia said low C-section rates were part of the appeal when she decided to use a midwife.
She learned of the impending changes at Swedish Hospital at the end of July and has since transferred care to a new hospital offering independent midwife services.
“Not everyone can do that,” Cecilia said. “There’s certain people who don’t have cars. I really feel for people who don’t have access to get to a different hospital with the same kind of midwifery care that they’re receiving [at Swedish] in the first place, especially so late in the game.”
