Deliveries of new life remain risky, ancient midwifery practice offers assistance.
In low- and middle-income countries, scaling up midwifery care could prevent 82 percent of maternal deaths, according to recent studies. This approach is at the heart of Mother Health International (MHI) in Northern Uganda, a birth center affiliated with Yale University.
MHI's midwife-centric approach focuses on community-based, personalized midwifery care, aiming to reduce maternal mortality through direct support, local outreach, and maternal education. Midwives like Eva Nangalo provide skilled delivery services, but also advocacy, personal support including transportation and essential supplies, and use of peer educators and village health teams to reach pregnant women in rural areas.
In contrast, the maternal care system in the United States tends to be more hospital- and physician-centric, involving obstetricians and high-technology interventions. Despite its advanced medical infrastructure, the U.S. still faces relatively high maternal mortality rates compared to other wealthy countries. One critique is that the U.S. system may lack the community-level personalized midwife support central to MHI’s model, which could potentially improve outcomes by focusing on timely, culturally sensitive, and continuous care.
Key differences include a focus on care providers, care setting, approach to support, focus, and maternal mortality rate. MHI's approach emphasizes trust, local engagement, resourcefulness, and continuous support within communities, while the U.S. system relies more on technological and hospital-based care.
However, resource differences, population scale, and healthcare infrastructure complexities mean these models serve different contexts and challenges. MHI’s approach is optimized for low-resource, rural settings, while the U.S. model addresses different epidemiological and healthcare access issues.
In the U.S., a startup called Millie, founded by Sharma, combines obstetric and midwifery services for women in clinics and virtually. Professional midwives certified through the North American Registry of Midwives are qualified for non-hospital births. The American College of Nurse-Midwives reported a 10.9 percent increase in births attended by midwives in 2022, up from 7.9 percent in 2012.
Midwife care can lower mortality rates, lead to fewer preterm births and low birthweight infants, and reduce interventions, like C-sections, in labor. Traditional midwives and doulas, who aren't formally licensed, can play a vital role in the birth process. The median cost of a healthy vaginal birth in the United States is almost $29,000, while midwifery is far less expensive and a more efficient way to deliver care.
Despite the progress, challenges remain. Since 2010, over 500 rural hospitals have closed their labor and delivery wards, with more closures expected. This gap in care is particularly pronounced in rural areas, where access to quality maternal healthcare is limited.
In summary, MHI's midwife-centric care is community-focused and personal, effectively addressing barriers in a low-resource context, while the U.S. system is more hospital-centered with technological reliance but struggles with maternal mortality partly due to less community-based continuity and access. Integrating midwifery-led, community care principles from MHI could inform improvements in U.S. maternal health services.
- The health-and-wellness industry in the United States is starting to incorporate midwifery principles, as seen in the startup Millie, which combines obstetric and midwifery services, aiming to reduce maternal mortality rates and interventions like C-sections.
- The science of midwifery plays a significant role in ecology and history, as evidenced by MHI's successful approach to scaling up midwifery care in low- and middle-income countries, such as Northern Uganda, saving countless lives and improving maternal health outcomes.
- Although cultures, resources, and healthcare infrastructures differ greatly, the role of community-based midwives in maternal health care cannot be overlooked, as demonstrated by the success of MHI in Uganda, and potentially by incorporating similar health-and-wellness principles into the U.S. maternal health system.
