“No person should simply accept their childbirth experiences as success,” said Gov. Ned Lamont, speaking on S.B. 896, the new law that creates licenses for freestanding birth centers. “…We are working to create better experiences for Connecticut’s families.”
The statute comes on the heels of a wave of hospitals requesting to close their labor and delivery suites. Just recently, Stafford’s Johnson Memorial hospital appeared before the state to petition to close their labor and delivery unit, placing them in a queue of two other hospitals requesting to do the same. If all three closures are approved, there will be only one rural hospital – Day Kimball – to offer labor and delivery services.
Labor and delivery closures is not a Connecticut- specific issue. Hospitals across the country are citing low patient volume and decreased profitability as the reason they’re shutting their doors. Yet 36% – more than one-third – of the country is considered to live in an area without access to maternal care. In the face of increasing maternal mortality rates and worsening maternal outcomes, state officials such as Lamont are turning to traditional maternal care models out-of-hospital birth centers and midwifery to fill in the cracks of our crumbling maternal care infrastructure.
It’s kind of ironic, really.
The modern U.S. maternal model of care, in which 98% of births take place in a hospital and nearly 90% are attended by obstetricians, was intentionally and meticulously crafted in the early 1900s by (white male) practitioners of the hot new medical field of obstetrics.
Labeled “The Midwife Problem,” OBs began legislative and social campaigns to disenfranchise (mostly Black) midwives -– calling them dirty, dangerous, and incompetent.
Newly graduated from medical school and pressed for social respect, physicians entering in the obstetric space saw midwives as a direct threat to their success. As Dr. Joseph Delee from Chicago voiced: “The public does not respect the obstetrician and will not pay him adequately …When the women demand a better standard of service and cease employing midwives Chicago: better service will be provided (Medical Education and the Midwife Problem In the United States). ”
Since the inception of obstetrics, maternal care ceased being about healthcare and began being about power. The birth room became an arena for a political and legislative battle, and those in labor became human collateral. From a 1910 Journal of American Association (JAMA) article:
“[t]he evils resulting from ignorant midwives are well known to physicians, but more education of the public and of the state legislatures will be required before midwifery is restricted. (Medical Economics: Vital Statistic Legislation a Necessity for Suppression of the Midwife Evil)”
In the 1900s, midwives delivered approximately 50% of births. By 1935, it was 15%.
But chickens come home to roost. Hospitals are a business, and like any other business, expect to make profits. As women moved from giving birth at home to the hospital setting, hospitals began implementing interventions that increased profits (and decreased liabilities). In 2021, the cesarian section rate was 32%. The average cost of childbirth in the U.S has tripled since 1996.
In March, The Wall Street Journal reported that maternal mortality rate is the highest it has been since 1965.
Part of S.B. 896 is the creation of a task-force comprised of at least six direct-entry/ certified professional (homebirth) midwives. My prediction is that, soon, Connecticut will license homebirth midwives to practice legally. This enables families that are anticipated to have low-risk, uncomplicated pregnancies to have their babies at home, alleviating the long commute times that some families will inevitably face as a byproduct of labor and delivery center closures.
By integrating homebirth midwives into our maternal care model, we also decrease the overload on central urban hospitals as the rural hospitals around them close. Without apology or acknowledgement, the U.S. is slowly returning to the model of care eradicated by obstetricians of the early 1900s.
Black lay midwives deserve their flowers – even when they’re 100 years too late.
Ashleigh Evans is a Student Nurse Midwife at the Yale School of Nursing.