Midwives May Help Save the Lives of Millions of Women

• A new study published this week in The Lancet Global Health suggests that scaling up midwife services could help fill gaps in healthcare access and reduce maternal mortality.
• Using more midwife services could result in 280,000 fewer deaths in mothers, 2 million fewer deaths in newborns, and more than 2 million fewer stillbirths per year by 2035.
• Even a modest increase in midwife-delivered care could result in substantially reduced maternal mortality.

Around the world, hundreds of thousands of women die every year from pregnancy-related causes.

More than 90 percent of those deaths occur in low-resource settings — and most could be prevented with improved access to high-quality healthcare.

A new study published this week in The Lancet Global Health suggests that scaling up midwife services could help fill gaps in healthcare access and reduce maternal mortality.

Improved access to midwife-delivered care could also cut the number of stillbirths and deaths among newborns, particularly in low-income countries.

“I strongly agree with the authors of this important paper and the conclusions they reach,” Dr. Frank Chervenak, chair of obstetrics and gynecology at Lenox Hill Hospital in New York City, told Healthline.

“[Most] maternal mortality occurs in low-income countries, and having qualified midwives would go a long way to reduce this,” he said.

Cut deaths by two-thirds

The new study was conducted by researchers from Novametrics Limited, the World Health Organization, the United Nations Population Fund, the University of Sydney, and the Burnet Institute.

The authors of the study used the Lives Saved Tool (LiST) to mathematically model the effects of increasing midwife-delivered healthcare in 88 low- and middle-income countries.

They focused on 30 interventions that can be delivered by competent and enabled midwives before, during, and after pregnancy. For example, these interventions ranged from blood pressure screening and diabetes management to childbirth and breastfeeding support.

The researchers found that providing universal access to midwife-delivered care could cut the rate of maternal mortality, newborn deaths, and stillbirths by up to two-thirds.

This could result in 280,000 fewer deaths in mothers, 2 million fewer deaths in newborns, and more than 2 million fewer stillbirths per year by 2035.

Even a modest increase in midwife-delivered care could result in substantially reduced maternal mortality, newborn deaths, and stillbirths.

Midwifery in the United States

While the new study highlights the potential benefits of midwife-delivered care in low- and middle-income countries, midwives also have a role to play in supporting families in high-resource nations such as the United States.

“Midwifery by qualified certified nurse midwives is a boon to modern obstetrics,” Chervenak told Healthline.

“One out of eight deliveries in hospitals in the United States are currently done by quality midwives,” he continued, “and indeed, I’d like to see this increase.”

Studies in the United States have found that midwifery care is linked to lower rates of medical intervention in childbirth, such as cesarean delivery. Midwife support is also linked to lower costs associated with childbirth.

Some research also suggests that midwifery care might help reduce racial disparities in maternal and infant health outcomes. However, midwife access is lower in communities where more Black babies are born.

Early education and care

According to Risa Klein, CNM, director of midwives at Lenox Hill Hospital, qualified midwives can play a crucial role in providing early care and education in pregnancy.

“Midwives encourage early care because if you come for your first prenatal visit at 12 weeks, then we’re missing the first trimester,” Klein said.

Midwives can help people who are pregnant or trying to get pregnant learn how to lower their risk of pregnancy-related complications through lifestyle changes and other strategies.

Midwives can also connect people who are at heightened risk of pregnancy-related complications to specialist physicians, who can help meet their complex care needs.

“Women that truly have medical problems, like liver disease, kidney problems, heart problems — these are patients that midwives do not take care of,” Klein said.

“We’re not surgeons, we’re not obstetricians, so we work in referrals and collaboration with these doctors,” she continued.

Institutional support and training

Like the authors of The Lancet Global Health study, Chervenak and Klein emphasize the importance of professional education and regulation for midwives.

“We need quality midwives. In the United States, that means certified nurse midwives — people who have had academic training,” Chervenak told Healthline.

Embedding midwives in healthcare centers where patients can access specialty care if needed can also help improve outcomes, Chervenak added.

“I’m an enthusiastic supporter of midwifery in the hospital,” he said.

“In obstetrics, most of the time, everything goes fine,” he said, “but when things go south, you need access to the subspecialists and intensive care units in an immediate way.”

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