Among high-income countries, the United States has one of the biggest rates of maternal mortality in the world. Last year, 1200 women died in— or through circumstances caused by—childbirth. There are 22 deaths for every 100,000 births— a number that is radically higher than, say, Norway, where maternal mortality is almost non-existent.
Like so many other aspects of healthcare in the United States, poor maternal outcomes trend overwhelmingly toward low-income or minority communities. Black mothers in particular have the highest rate of poor outcomes.
In this article, we take a look at what factors influence pregnancy outcomes, and how nursing midwives might play a part in making the difference.
What Factors Impact Pregnancy Outcomes the Most?
The primary indicator of how a woman will respond to pregnancy is biological. Some women are simply genetically predisposed to high blood pressure, diabetes, or other factors that can significantly influence the direction of a pregnancy.
These aspects can be managed by a good team of doctors and nurses, but there is ultimately only so much that can be done to control for them.
Accessibility to prenatal care is a major factor that can be influenced. Women who can get regular appointments with a doctor or midwife will detect problems early, and receive better advice on how to manage them.
It is naturally for this reason that low-income mothers often experience the worst outcomes. They may not have the financial ability to go to the doctor every two weeks.
That said not all of the minority mothers who experience bad pregnancy outcomes are low-income. Serena Williams famously almost lost her life giving birth several years ago. Obviously, you can’t extrapolate an individual’s experience into a wider social context without further evidence.
That said, there is consistency in the form of communication gaps. Williams herself has described this same issue in reporting on her maternal experiences with the healthcare system.
It is harder for black women to be taken seriously by their doctors and nurses than it is for white women.
The problem is not that doctors and nurses do not want to provide high-quality care to minorities. Mostly, it comes down to communication gaps. An inability for people of a primarily majority group background to fully relate to and understand minority patients.
Can midwives make a difference?
What is a Midwife?
A midwife provides care before, during, and after childbirth. They work with the mother to develop a plan that she is comfortable with. While there is sometimes a modern “wooey,” connotation around midwifery, it is actually mainstream medicine with deep historical routes.
Before modern healthcare infrastructure developed to the point that it now has, it was midwives who would administer the majority of prenatal care.
People often choose midwives for a more personalized birthing experience. Midwives typically spend more time with patients, offer more emotional support, and promote natural birth processes when possible. They often have lower intervention rates for low-risk pregnancies.
Some prefer midwives for their holistic approach, focusing on the mother’s overall well-being, not just medical aspects. Midwife-led care can be less expensive and may result in fewer unnecessary medical interventions.
However, it’s important to note that midwives usually work with low-risk pregnancies. High-risk cases are generally referred to obstetricians.
Does that mean they can’t impact maternal health outcomes?
Not necessarily. It is true that their influence is limited primarily to mothers who fall in the “low-risk,” category.
However, low risk is definitely not the same thing as no risk. Having a baby is a serious enterprise. Any birth can result in complications for both the mother and the child.
Nursing midwifery positions provide patients with more care options. This can create both tangible and intangible benefits in their overall outcomes. In concrete terms, we already mentioned the statistical benefits of receiving care from someone who shares or at least can relate to your background.
If a minority, patient can’t find a doctor with cultural similarities to them, they may still be able to find someone they relate to through midwifery.
Abstractly it’s also just beneficial to feel comfortable with and confident in your care provider. The more options have the more likely you’ll wind up with someone you like.
Conclusion
No, nursing midwives are not necessarily the cure to America’s maternity problem. Like many of our healthcare issues, this is a problem that will probably be solved through legislative effort. Accessibility issues are what keep most Americans from achieving their best possible healthcare results. As a nation, we have access to some of the best medical minds and equipment on the planet.
Why do we still have wrongful deaths? It’s often an accessibility issue. Nursing midwives do not fix the problem of unaffordable healthcare. However, they can play an important part in expanding people’s options and diversifying treatment.
Interested in a rewarding career you will love? Consider learning more about what it takes to participate in the healthcare system as a nursing midwife.