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Certified Nurse Midwives

Study Shows Nurse-Midwives a Better Option for Most Pregnant Women

Many hospitals subject pregnant women to unnecessary hi-tech medical intervention when they give birth, and ignore the benefits offered by certified nurse-midwives (CNMs), according to an article from Public Citizen’s Health Research Group published September 1 in the medical journal Public Health Reports, an official publication of the United States Public Health Service.

The article, “The Beneficial Alternative: Nurse-Midwifery,” reports that although most pregnancies and births do not require medical intervention, certain obstetric procedures like ultrasonography and electronic fetal monitoring are used in most deliveries directed by physicians. Women who have their babies without CNMs are also more likely to be denied room to walk around during labor to ease their discomfort, more likely to be denied the use of a bath or shower during their labor, and more likely to undergo unnecessary cesarean surgery.

“Instead of a last-minute rush to deploy all the latest expensive equipment, hospitals should see childbirth for what it is — a normal event,” said Dr. Sidney Wolfe, Director of Public Citizen’s Health Research Group and co-author of the article with Mary Gabay. “Nurse-midwives provide more individualized care, and they reduce the rate of expensive medical interventions.”

Although the preference for in-hospital midwife-attended births in the US is growing, up from 19,686 in 1975 to 196,977 in 1994, only about 5 percent of births in the US happen in this way, whereas in Europe midwives are the principal attendants for over 75 percent of births. The US also has a relatively high infant mortality rate — in 1994 it ranked 21st among other major developed countries.

“For most pregnant women, certified nurse-midwives offer a better alternative than physicians,” said Dr. Wolfe. “Certified nurse-midwives offer the sort of care not provided by many hospitals.” The article shows that nurse-midwifery care results in outcomes similar to those achieved by physicians, often at much lower cost.

In a rejoinder article accompanying the Public Citizen piece, Dr. Hal C. Lawrence, an obstetrician and co-chairman of an American College of Obstetricians and Gynecologists Committee, rejects the suggestion that CNMs are often the best option, charging that “collaborative teams of physicians and advance practice professionals” are preferable.

Dr. Wolfe vigorously opposed the suggestion that doctors always know best. “Diminishing the importance of the crucial independent role played by nurse-midwives is insulting to their talent and expertise. Reducing these highly-trained professionals to the role of physicians’ handmaidens is outrageous.”

The Public Citizen authors analyzed a list of options usually offered by CNMs and compared how many were offered to non-CNM patients (under the care of ob-gyn doctors) at the same hospitals. They found that during labor and delivery, CNM patients were more likely than non-CNM patients to be offered oral fluids, to ambulate during labor, to be encouraged to use alternative positions for delivery and to be allowed friends in attendance at the birth.

“More CNMs should be trained, and the public made aware of their effectiveness. In many states, restrictive regulation hinders CNMs. These restrictions include limitations on hospital admitting privileges, prescribing privileges and lack of mandatory third-party insurance reimbursement,” said Dr. Wolfe.

Florida, by contrast, is aggressively promoting the use of CNMs as a cost-effective answer to a shortage of maternal health care providers. Florida aims to have 50 percent of healthy pregnant women cared for by midwives by the year 2000 and aims to train 600 additional nurse-midwives by that year.

“If other states follow Florida’s lead, excessive use of costly and needless medical interventions can be cut, and the infant mortality rate greatly improved,” said Dr. Wolfe.

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Copies of the article “The Beneficial Alternatives: Nurse-Midwifery” are available upon request. You may also wish to read about out report Delivering a Better Childbirth Experience, available from Public Citizen.