Home What is a midwife? Midwifery today Quality and cost of care Find a midwife Useful links About the author
Although nurse-midwives typically prescribe fewer drugs, use fewer tests and choose lower cost treatments and settings than physicians, 93 percent of the 4 million babies born each year in the United States are delivered by physicians, most of whom are surgical specialists in obstetrics. 4
Midwife Lynne Salzburg comforts Suzanne Romans, 22, during hard
labor. After ten hours of labor at the birth center, Romans went to a
hospital because of a minor complication and delivered a healthy boy
with a physician. Salzburg has informal agreements with some physicians,
but does not have hospital privileges.

Quality and Cost of Care

Birth centers, which typically have fewer overhead costs than hospitals, create a considerable difference in price for consumers. The average cost of a birth in a birth center with a midwife was about $3,000 in 1995, while the cost of a hospital birth with a physician was twice as much.4 Although many women choose to give birth at home or in birth centers, 99 percent of births still occur in hospitals, where care is more costly.

Despite the higher cost of a hospital birth, the level of care a woman receives with a midwife is as good or better than that which she gets with a physician. A 1995 report on the use of nurse-midwives found midwifery to be a "common-sense" solution to reducing medical costs, "while still providing quality care to pregnant women and newborns." 1 The report, which was based on a survey of midwife practices, found that women who are cared for by nurse-midwives "can look forward to longer prenatal visits, a greater emphasis on education and birth preparation during the prenatal period, and greater emotional support."

Midwives also use fewer surgical procedures and medication during labor and delivery. According to a consumer report on health, Caesarean sections are performed in about 20 percent of births -- "well above the estimated 12 to 14 percent that are medically justified."3 The report recommends that women consider delivery in a hospital by a certified nurse-midwife because they are far less likely to require the operation than obstetricians. Most C-sections are done to speed up labor, the report states, but midwives are more likely to employ other less invasive techniques -- medication, deliberate rupture of the membranes surrounding the fetus, massage or even a warm shower -- to stimulate labor.

Obstetricians also regularly perform episiotomies -- cutting of the skin and muscles in and around the lower vaginal wall -- to ease delivery. But according to the consumer report, episiotomy causes more tears than it prevents. The report advises women to tell their care provider that they want to avoid episiotomy if possible.

A study shows that babies delivered by midwives are also just as healthy, if not more so, than those delivered by physicians. According to a 1993 analysis of several studies of births assisted by either certified nurse-midwives or doctors, babies delivered by the midwives "fared as well as or better than those delivered by doctors, even thought those cared for by doctors were at no greater risk for a poor outcome."2 The babies delivered by the midwives were more likely to be born vaginally without induction of labor, fetal monitoring, forceps delivery or episiotomy; they were also less likely to be born prematurely or with an abnormally low birth weight and tended to have higher scores on the Apgar scale of several signs of a newborn’s condition five minutes after birth; women also had shorter hospital stays and were more than twice as likely to breast-feed their babies.

1 American Political Network, Inc. "Nurse-Midwives: Public Citizen Releases Consumer Guide." American Health Line. November 7, 1995.

2 Brody, Jane E. "Personal Health." New York Times. April 28, 1993, late ed.-final:C11.

3 Consumers Union of U.S., Inc. Consumer Reports on Health. March, 1998. Vol. 10, No. 3, pp. 1, 3-5.

4 Dower CM, Miller JE, O'Neil EH and the Taskforce on Midwifery. Charting a Course for the 21st Century: The Future of Midwifery. San Francisco, CA: Pew Health Professions Commission and the UCSF Center for the Health Professions. April 1999. pp 1, 2.

Images and words © Copyright 2000 Molly Van Wagner
Last revised: 4.20.2000