Midwives can be an Rx to America’s maternal mortality crisis

ABC News

(NEW YORK) -- Ashley Watts is getting ready to become a first-time mom.

“This pregnancy ride has been very fulfilling,” Watts, 32, told ABC News.

For Watts, this pregnancy journey is different. She has previously suffered five pregnancy losses, telling ABC News that she now suffers from hospital anxiety after feeling dismissed and unsupported by her doctors as she tried to navigate those losses and pursue motherhood.

When she learned of her most recent pregnancy, Watts decided she wanted to work with a midwife and dreamed of welcoming her baby into the world at a birthing center. The cost of midwifery care, however, was a barrier in allowing Watts access to the care she felt was better suited to her needs.

A 2021 study published in the International Journal of Environmental Research and Public Health found that midwife-assisted home births in the United States cost an average of $4,650. In many cases, insurance does not cover these births, according to the study.

After going to a consultation appointment with midwife Allegra Hill at Kindred Space LA, Watts learned of birthFUND, a new initiative by Elaine Welteroth, an author and former Teen Vogue editor-in-chief, that provides need-based grants to expectant mothers and families to use for holistic perinatal care and midwifery birth support services.

“I really don't believe that quality, holistic, safe maternal health care should be seen as a luxury in one of the wealthiest countries in the world,” Welteroth told ABC News. “And there is something we can do about it.”

Welteroth launched birthFUND in April of this year during Black Maternal Health week, inspired by her own experience seeking care during her first pregnancy.

“I thought, how hard could it be to find a doctor? You know, I live in LA, I have resources, I have a great network,” Welteroth said. “And I just had bad experience after bad experience.”

Discouraged and nearing her third trimester, Welteroth found Kim Durdin, midwife and co-founder of Kindred Space LA.

“As a new mom, giving life in a country that's in a surging maternal mortality crisis, I thought I should be able to ask questions about my health, about my body, about the kinds of decisions that I could make throughout the process, and midwives embrace that, they encourage that,” Welteroth said.

“I think I came out of my birth experience feeling this deep conviction to pay it forward,” she said. “I just felt like if there is anything I can do to help make sure that midwifery care is accessible to families who want this kind of care, then, like, that's my calling.”

Dr. Laurie Zephyrin, a board-certified OB-GYN and the senior vice president for Advancing Health Equity at The Commonwealth Fund, told ABC News that there are a lot of misconceptions around midwifery care, adding that there needs to be a lot more education about the benefits and opportunities involved with using a midwife.

Midwives are also clinicians, trained to help guide people through the birthing process, she said. 

“There’s definitely data that shows that people that have a midwife during their care have improved outcomes,” Zephyrin said.

Zephyrin is one of the authors in a recent study by The Commonwealth Fund that analyzed maternal mortality data in the United States and 13 other high-income nations, finding that maternal mortality rates in the U.S. continue to far exceed that of other high-income nations.

According to the latest report by the Centers for Disease Control and Prevention (CDC), the maternal mortality rate in the U.S. fell in 2022 after three years of continuous increase. Findings by The Commonwealth Fund’s study suggest two-thirds of all maternal-related deaths in the United States happen postpartum and are frequently the result of high blood pressure, severe bleeding, infection and cardiomyopathy.

“One of the advantages of what we saw when we compared to other high-income countries is that there's someone that comes to your home and sees you during the postpartum period, they check on you, they help answer questions,” Zephyrin said.

“And that continues throughout the postpartum period, and that leaves an opportunity so that things don't fall through the cracks,” she continued.

For Black women like Watts, who are at a higher risk of dying from pregnancy-related complications in the United States, access to midwifery care can be even more critical.

Despite the decrease, the rate of maternal deaths for Black women in the United States remained significantly higher than other racial groups, the CDC report found. In 2022, an average of 19 white women died per 100,000 live births, while an average of 49 Black women died for every 100,000 live births.

According to the World Health Organization, including midwifery in family planning could help avert more than 80% of all maternal deaths, stillbirths and neonatal deaths. Zephyrin’s team found that the U.S. has the second lowest number of midwives for every 1,000 births, and that most countries with the lowest mortality rates rely heavily on midwives.

According to data projections by the National Center for Health Workforce Analysis, the United States is predicted to face an OB-GYN shortage, with an estimated 5,000 obstetricians expected to leave the workforce in the next 12 years. Making midwifery care more accessible can help alleviate the need for OB-GYN care providers while allowing expectant families access to holistic, perinatal care.

While approximately 3.66 million live births happen in the United States annually, there are currently about 12,650 registered midwives, according to data by the CDC and the National Center for Health Workforce Analysis.

“I really believe that people need to be educated more about what midwives can do and the opportunities for midwifery care in this country,” Zephyrin said. “Midwives are clinical providers, and they can provide this holistic aspect of care that's really critical in what people want in our maternal health care system.”

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