Midwifery works; we shouldn't deny women choice.

Byline: GUEST VIEWPOINT By Carla Viles and Melissa Cheyney For The Register-Guard

On Jan. 1, Springfield women lost access to hospital-based midwifery care in their community. As Dr. Zena Mongi, an obstetrician and chief of staff at McKenzie-Willamette Medical Center, explained in the Dec. 9, 2005, Register-Guard: "It's not because there isn't support for midwifery. ... Every ob-gyn there feels supportive of McKenzie's midwifery practice. It comes down to time and money."

This scenario is all too common. Nationwide, birthing centers are closing and families are being denied choice in maternity care, even as physicians and administrators profess `support for midwifery." Such is the case in Oregon, where state law has long protected midwives' right to practice outside the hospital and women's right to have their babies in birth centers or at home.

Recent research clearly demonstrates the safety and efficacy of midwife-attended birth, leading us to question just what constitutes the medical community's reported `support.' If American physicians and birthing families are interested in improving maternal and infant well-being, then we need to follow the lead of other nations that have cut costs and improved outcomes by supporting the midwifery model of care.

The National Center for Health Statistics reported last year that the rate of cesarean section in the United States, at 29.1 percent, is the highest it has ever been, up 6 percent from 2002. The Eugene-Springfield rate is more than 30 percent. The percentage of mothers undergoing surgical delivery for the first time is also at an all-time high: 20.8 percent, up 6 percent since 2002.

If these increases were associated with improved results, they might be applauded. However, the United States has not reported a decrease in maternal mortality rates since 1982. Infant mortality rates, which had been declining steadily since 1958, have been on the rise since 2001. In 20 other nations, more babies survive their first month of life than in the United States.

The United States now ranks 21st for maternal mortality and 28th for infant mortality among 29 wealthy nations. Several poorer nations, including Cuba and the Czech Republic, boast superior outcomes while spending much less per capita. All nations with lower maternal and infant mortality rates offer universal health care and have midwives attending most births.

The Midwives Alliance of North America recently completed the largest prospective study of 5,418 home births involving certified professional midwives in the United States and Canada. While planned home births of low-risk women were proven as safe as low-risk hospital births, the rate of intervention - such as epidurals, forceps and surgical delivery - was significantly lower, with a cesarean rate of only 3.7 percent.

The authors conclude: Certified professional midwives ``achieve good outcomes among low-risk women without routine use of expensive hospital interventions.'' The data support the American Public Health Association recommendation for increased access to out-of-hospital maternity care with direct-entry midwives.

What makes midwives such excellent providers of maternity care? The answer brings us back to the original culprits - time and money. Forming a relationship with the families they serve, midwives spend time listening to women, answering questions, addressing fears. They have time to offer counsel on nutrition, exercise and sometimes even marriage! Midwives take time to be with women as they labor and give birth. They help establish breastfeeding and guide mothers through the postpartum adjustment. In maternity care, time truly does equal money; a small amount of time spent in holistic care greatly reduces the need for expensive medical interventions. For normal healthy women, relationships often trump technology.

For most women, pregnancy and birth are normal life events. Midwives are the main providers of care in 75 percent of all European births. Modern midwives embrace the value of medical care, are trained to recognize abnormal conditions and are prepared to work with doctors when appropriate.

It is now time for doctors to reciprocate, truly supporting midwives to the benefit of good health for the mothers and babies in our community.

Carla Viles is a direct-entry midwife in private practice in Eugene since 1992 and the mother of five children, three of whom were born at home. Melissa Cheyney is a professor of medical anthropology and women's health at Oregon State University and a direct-entry midwife in private practice in Eugene since 2002. Both are members of the Oregon Midwifery Council.