The Nov. 25 article “Midwives could be key to reversing maternal mortality trends” points a lot of fingers but lacks a focus on more collaborative, team-based patient care. The participation of both ob-gyns and midwives in the health care system is critical to ensuring that all women have a safe childbirth.
Therefore, it is counterproductive to use inaccurate statistics like the one mentioned in the article, which claimed that 80 percent of maternal deaths could be averted if midwives were “scaled up.” Promoting this type of statistic without including the proper context only serves to further confuse and frighten patients about the state of U.S. maternity care.
That statistic was pulled from a United Nations report on pregnant women in developing countries with little to no access to prenatal care, reflecting numbers in places such as Sierra Leone, where nearly 700 women out of every 100,000 women who give birth die.
As a developed country, the United States should certainly be ashamed of its maternal mortality rate of 26 deaths per 100,000 births and move swiftly to reduce it, but the truth is that 99 percent of all maternal deaths occur in developing countries. In the United States, many women, like Evelyn DeGraf, are fortunate enough to be able to choose between a few health care options, one of which includes access to providers who are equipped to perform lifesaving surgical procedures if a childbirth goes wrong. Women in many developing countries do not have that luxury.
Despite these advantages, the truth is there isn’t just one simple solution — and no single provider — that is the key to reducing maternal mortality. That is why the American College of Obstetricians and Gynecologists (ACOG), the leading organization representing ob-gyns across the country, is working on several initiatives to address this crisis, including interprofessional education training models funded through the Josiah Macy Jr. Foundation.
These models, which are a joint effort with the American College of Nurse-Midwives (ACNM), are designed to improve and grow the maternity workforce by educating midwifery students alongside ob-gyn residents in ob-gyn residency clinical sites. Additionally, the Improving Access to Maternity Care Act, a bill ACOG has lobbied for alongside ACNM, will soon head to the president’s desk for signature. This bill ensures that the National Health Service Corps sends ob-gyns and midwives to areas of the country with the greatest need, bringing essential care to pregnant women.
Both ACOG and ACNM share a common vision for women’s health care and believe in providing the safest, highest-quality patient-centered care possible. We need to nurture the relationship between ob-gyns and midwives rather than threatening it if we truly want the best outcomes for mothers and babies.
Amanda N. Kallen, MD, is Chair, and Brian Riley, DO MPH, is Vice Chair of the Connecticut Section ACOG.