People giving birth report more positive experiences when cared for by midwives in both hospitals and in community settings than by physicians, according to a new study published in the journal Reproductive Health. Additionally, those receiving midwifery care at home or at birth centers reported better experiences than those in hospital settings.
The majority of U.S. births (88%) are attended by physicians, while midwives attend 12% of births. Most births occur in the hospital, with less than 2% of all births occurring in community settings, including homes and freestanding birth centers. Most community births are attended by midwives.
Measures of quality around maternity care often focus on clinical markers such as complications or rates of C-sections, leaving the lived experience of childbearing people unmeasured and neglected.
“In contrast to the standard obstetrical model, midwifery care is rooted in a philosophy that honors pregnancy and birth as a physiological, social and cultural process, not solely a clinical event,” write the authors, including lead author Mimi Niles, PhD, MPH, CNM, assistant professor at NYU Rory Meyers College of Nursing. “The care relationship between the client and the midwife serves as the primary vehicle through which values such as autonomy, respect, and informed decision-making are operationalized to preserve an overall satisfying experience of childbearing.”
To better understand people’s experiences during childbirth, the researchers examined 1,771 responses to the national Giving Voice to Mothers survey assessing four domains of the childbirth experience: communication and decision-making autonomy, respect, mistreatment, and time spent during visits. The researchers then analyzed differences between provider type and birth settings, breaking responses down into those cared for by a midwife at a community birth, a midwife at a hospital birth, and a physician at hospital birth.
Compared to those cared for by physicians in hospitals, individuals cared for by midwives in community settings had more than five times the odds of experiencing higher autonomy and were five times more likely to report that their provider showed them high levels of respect. They also reported lower odds of mistreatment.
The researchers also found significant differences across birth settings: patients cared for by midwives at home or birth centers had significantly better experiences than those in the hospital settings across all four measures-;autonomy, respect, mistreatment, and time spent. For instance, people cared for by midwives in the community were 14 times more likely to report having enough time in prenatal visits than those cared for by physicians, while people receiving midwifery care in hospital settings were nearly twice as likely to report having enough time during prenatal visits. Their findings generate more evidence that while the midwifery care model offers enhanced experiences of care, access to midwifery across all settings is needed to improve health outcomes for birthing people.
“Our findings add to evidence showing the model itself seems to be strongly influenced by the setting in which care is given-;with community settings (home and free- standing birth centers) offering greater likelihood of support and the hospital settings being limited by the constraints of a medical approach to care which deprioritizes experiential outcomes,” Niles and her co-authors write.
Niles, P. M.., et al. (2023) Examining respect, autonomy, and mistreatment in childbirth in the US: do provider type and place of birth matter?. Reproductive Health. doi.org/10.1186/s12978-023-01584-1.