A new study suggests that expanded use of midwives can improve care while greatly reducing the cost of birthing babies in the United States, which is, by far, the highest in the world.
The average cost of childbirth in the U.S. is $9,775 for a vaginal birth and $15,041 for a Caesarean birth (C-section), according to The New York Times. These costs are over twice as much as the costs for the nations in second place, which is $4,039 for a vaginal birth in Switzerland and $6,441 for a C-section in France.
The average total cost, when including the entire pregnancy and newborn care, and both what insurance pays and out of pocket costs, are about $30,000 for vaginal deliveries and $50,000 for C-sections. (For comparison, the "royal birth" cost $15,000.) This amounts to about $50 billion each year for all births in the U.S.
Additionally, the costs of childbirth in the U.S. rose 49 percent for vaginal births and 41 percent for C-sections from 2004 to 2010.
After a systematic review of 13 global studies including a total of 16,242 women, a new study found that midwives (called certified nurse midwives or CNM's in the U.S.), can deliver babies just as well as, and in some ways better than, doctors.
In "Midwife-led continuity models versus other models of care for childbearing women," published in the Aug. 21 edition of Cochrane Database of Systematic Reviews 2013, researchers Jane Sandall, Hora Soltani, Simon Gates, Andrew Shennan and Declan Devane found no adverse effects from a midwife-led birth. Midwife-led births used fewer epidurals, fewer episiotomies, and fewer instrumental births (the use of forceps or some other instrument). Also, women who gave birth with a doctor were in labor longer than those who give birth with a midwife.
In some randomized tests, where women were assigned either a doctor or midwife, the women with midwives were less likely to have a premature birth and there was no difference in the likelihood that the baby would die before or during delivery. The likelihood of a C-section was about the same for doctor care and midwife care. (Only doctors perform C-sections, so a patient under the care of a midwife will be transferred to a doctor if she needs a C-section.)
While midwives are fairly common around the world, in the U.S., only about eight percent of all births, or 12 percent of vaginal births, are led by midwives.
Besides the better outcomes for mother and child the findings of this study suggest that the high cost of birthing babies in the U.S. can be greatly reduced by more expansive use of midwives. Doctors are more expensive than midwives, and doctor-based deliveries are done in hospitals, which are more expensive than midwife-based birthing centers or home births.